Provider Demographics
NPI:1336140466
Name:ORTLIP, STEPHEN ALLISON (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ALLISON
Last Name:ORTLIP
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:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-0623
Mailing Address - Country:US
Mailing Address - Phone:434-447-3651
Mailing Address - Fax:434-447-2657
Practice Address - Street 1:606 N THOMAS ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-1422
Practice Address - Country:US
Practice Address - Phone:434-447-3651
Practice Address - Fax:434-447-2657
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20400208800000X
VA0101252671208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4044512OtherAETNA
OK340015276OtherRAILROAD MEDICARE
OK100173010AMedicaid
OK$$$$$$$$$RMedicare PIN
OKA94503Medicare UPIN