Basic Information
| Provider Information | |||||||||
| NPI: | 1134111875 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OSTROFF | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | BENJAMIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4037 TAYLOR RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233215535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574831403 | ||||||||
| FaxNumber: | 7574833757 | ||||||||
| Practice Location | |||||||||
| Address1: | 4037 TAYLOR RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233215535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574831403 | ||||||||
| FaxNumber: | 7574833757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 0101024700 | VA | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 19-00045 | 01 | VA | UNITEDHEALTH CARE | OTHER | 25063 | 01 | VA | OPTIMA/SENTARA | OTHER | 011194 | 01 | VA | BLUE CROSS/BLUESHIELD | OTHER | 7550839 | 05 | VA | MEDICAID | 0559K | 01 | NC | BLUE CROSS/BLUE SHIELD | OTHER | 221915 | 01 | VA | MAMSI/OPT CHOICE/MDIPA | OTHER |