Provider Demographics
NPI:1134804990
Name:KOLWICZ, MEGAN (RDN)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:KOLWICZ
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 1:11906 FALLING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-3263
Mailing Address - Country:US
Mailing Address - Phone:571-234-0814
Mailing Address - Fax:
Practice Address - Street 1:1031 STERLING RD
Practice Address - Street 2:
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:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86329677133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered