Provider Demographics
NPI:1851643480
Name:LOUGHREY, KATHLEEN A
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:LOUGHREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ARCH PL
Mailing Address - Street 2:UNIT 477
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-6578
Mailing Address - Country:US
Mailing Address - Phone:301-869-1787
Mailing Address - Fax:
Practice Address - Street 1:60 MARKET ST
Practice Address - Street 2:#206
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-6548
Practice Address - Country:US
Practice Address - Phone:301-869-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDB00159133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered