Provider Demographics
NPI:1487825675
Name:ORNSTEIN, DEBORAH A
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:ORNSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WV
Mailing Address - Zip Code:26426-1088
Mailing Address - Country:US
Mailing Address - Phone:304-782-3765
Mailing Address - Fax:304-782-1857
Practice Address - Street 1:193 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WV
Practice Address - Zip Code:26426-1229
Practice Address - Country:US
Practice Address - Phone:304-782-3765
Practice Address - Fax:304-782-1857
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030481000Medicaid
WV3810005016Medicaid