Provider Demographics
NPI:1508362757
Name:MCCLATCHEY, ROBERT (DME PROVIDER)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MCCLATCHEY
Suffix:
Gender:M
Credentials:DME PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17865 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2411
Mailing Address - Country:US
Mailing Address - Phone:540-288-6828
Mailing Address - Fax:800-584-0815
Practice Address - Street 1:17865 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2411
Practice Address - Country:US
Practice Address - Phone:703-763-2687
Practice Address - Fax:800-584-0815
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206010050332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0206010050OtherMEDICAL EQUIPMENT SUPPLIER PERMIT