Provider Demographics
NPI:1154576932
Name:MCFALLS, MARY KATHLEEN (MS,RD, LD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN
Last Name:MCFALLS
Suffix:
Gender:F
Credentials:MS,RD, LD
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:MCFALLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,RD, LD
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:1221 MERCANTILE LN
Practice Address - Street 2:KAISER PERMANENTE LARGO MEDICAL CENTER
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5374
Practice Address - Country:US
Practice Address - Phone:301-618-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI146133V00000X
MDN00059133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered