Provider Demographics
NPI:1356781744
Name:TALBOTT, CORY JO (RDN, LDN)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:JO
Last Name:TALBOTT
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 WALKER LN
Mailing Address - Street 2:SUITE 309
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3245
Mailing Address - Country:US
Mailing Address - Phone:703-644-4461
Mailing Address - Fax:866-212-1244
Practice Address - Street 1:6355 WALKER LN
Practice Address - Street 2:SUITE 309
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3245
Practice Address - Country:US
Practice Address - Phone:703-644-4461
Practice Address - Fax:866-212-1244
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6234223132700000X
133NN1002X
1007882133V00000X
MDDX3223133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education