Provider Demographics
NPI:1194090928
Name:MARCO, ALLISON (RD)
Entity type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:
Last Name:MARCO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1833
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20146-1833
Mailing Address - Country:US
Mailing Address - Phone:571-241-7000
Mailing Address - Fax:
Practice Address - Street 1:1360 BEVERLY RD STE 102
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3621
Practice Address - Country:US
Practice Address - Phone:571-241-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1008496133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered