Provider Demographics
NPI:1629822671
Name:JUDGE, MADISON (RDN)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:JUDGE
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 1:3797 KATIE PL
Mailing Address - Street 2:
Mailing Address - City:TRIANGLE
Mailing Address - State:VA
Mailing Address - Zip Code:22172-2044
Mailing Address - Country:US
Mailing Address - Phone:703-244-7341
Mailing Address - Fax:
Practice Address - Street 1:461 CARLISLE DR STE A
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5620
Practice Address - Country:US
Practice Address - Phone:703-244-7341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered