Provider Demographics
NPI:1912306408
Name:SEIDMAN, KATRINA
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:SEIDMAN
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 1:1360 BEVERLY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3643
Mailing Address - Country:US
Mailing Address - Phone:703-552-2722
Mailing Address - Fax:
Practice Address - Street 1:1360 BEVERLY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3643
Practice Address - Country:US
Practice Address - Phone:703-552-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered