Provider Demographics
NPI:1093898876
Name:THE FITTING ROOM
Entity Type:Organization
Organization Name:THE FITTING ROOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:W
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-580-2999
Mailing Address - Street 1:168 POTOMAC WAY LANE
Mailing Address - Street 2:
Mailing Address - City:HEATHSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22473
Mailing Address - Country:US
Mailing Address - Phone:804-580-2999
Mailing Address - Fax:804-580-2999
Practice Address - Street 1:168 POTOMAC WAY LANE
Practice Address - Street 2:
Practice Address - City:HEATHSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22473
Practice Address - Country:US
Practice Address - Phone:804-580-2999
Practice Address - Fax:804-580-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009100130Medicaid
VA0187780001Medicare UPIN
VA009100130Medicaid