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General NPI Number Information
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NPI Number | 1508362757
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Entity Type | Individual
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Provider Name | ROBERT MCCLATCHEY DME PROVIDER
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Gender | Male
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 17865 MAIN ST STE B
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City | DUMFRIES
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State | VA
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Zip | 22026-2411
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Country | US
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Telephone | 703-763-2687
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Fax | 800-584-0815
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Provider Business Mailing Address
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Address Line | 17865 MAIN ST STE B
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City | DUMFRIES
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State | VA
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Zip | 22026-2411
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Country | US
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Telephone | 540-288-6828
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Fax | 800-584-0815
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0206010050
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License Number State | VA
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