Provider Demographics
NPI:1134111875
Name:OSTROFF, EDWARD BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BENJAMIN
Last Name:OSTROFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4037 TAYLOR RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5535
Mailing Address - Country:US
Mailing Address - Phone:757-483-1403
Mailing Address - Fax:757-483-3757
Practice Address - Street 1:4037 TAYLOR RD
Practice Address - Street 2:SUITE A
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5535
Practice Address - Country:US
Practice Address - Phone:757-483-1403
Practice Address - Fax:757-483-3757
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101024700208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA19-00045OtherUNITEDHEALTH CARE
VA25063OtherOPTIMA/SENTARA
VA011194OtherBLUE CROSS/BLUESHIELD
VA7550839Medicaid
NC0559KOtherBLUE CROSS/BLUE SHIELD
VA221915OtherMAMSI/OPT CHOICE/MDIPA
VA7550839Medicaid