Provider Demographics
NPI:1417403239
Name:MCDONOUGH, EMILY KATHERINE (RDN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHERINE
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 STERLING RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3865
Mailing Address - Country:US
Mailing Address - Phone:703-466-5150
Mailing Address - Fax:703-649-3557
Practice Address - Street 1:1031 STERLING RD
Practice Address - Street 2:SUITE 203
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3865
Practice Address - Country:US
Practice Address - Phone:703-466-5150
Practice Address - Fax:703-649-3557
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86032855133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered