Provider Demographics
NPI:1164644779
Name:TOBIN S NAIDORF MD PLLC
Entity Type:Organization
Organization Name:TOBIN S NAIDORF MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:TOBIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAIDORF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-799-1688
Mailing Address - Street 1:7910 ANDRUS RD
Mailing Address - Street 2:#6
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3171
Mailing Address - Country:US
Mailing Address - Phone:703-799-1688
Mailing Address - Fax:703-799-4092
Practice Address - Street 1:7910 ANDRUS RD
Practice Address - Street 2:#6
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3171
Practice Address - Country:US
Practice Address - Phone:703-799-1688
Practice Address - Fax:703-799-4092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043875174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1457306318OtherNPI
VA006043003Medicaid
VA181852OtherPTAN
VA181852OtherPTAN