Provider Demographics
NPI:1194965830
Name:ITTOOP, SABITA M (MD)
Entity type:Individual
Prefix:DR
First Name:SABITA
Middle Name:M
Last Name:ITTOOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 ELDEN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4875
Mailing Address - Country:US
Mailing Address - Phone:201-960-3001
Mailing Address - Fax:
Practice Address - Street 1:171 ELDEN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4875
Practice Address - Country:US
Practice Address - Phone:703-689-2020
Practice Address - Fax:703-485-1153
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101253897207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10673Medicare PIN