Healthcare Provider Details

I. General information

NPI: 1902015522
Provider Name (Legal Business Name): THE TRAINING ROOM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 COMMERCE RD
FOREST HILL MD
21050-2565
US

IV. Provider business mailing address

PO BOX 611
HAMPSTEAD MD
21074-0611
US

V. Phone/Fax

Practice location:
  • Phone: 410-374-4000
  • Fax: 410-374-5000
Mailing address:
  • Phone: 410-374-4000
  • Fax: 410-374-5000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number12244503
License Number StateMD

VIII. Authorized Official

Name: WILLIAM A BOLESTA
Title or Position: PRESIDENT
Credential: ATC BOC
Phone: 410-374-4000