Provider Demographics
NPI:1629028550
Name:ORNDORFF, TIFFANY L (DO)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:ORNDORFF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15769 WC MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-7327
Mailing Address - Country:US
Mailing Address - Phone:804-419-9760
Mailing Address - Fax:804-378-9140
Practice Address - Street 1:15769 WC MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-7327
Practice Address - Country:US
Practice Address - Phone:804-419-9760
Practice Address - Fax:804-378-9140
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA153011OtherSOUTHERN HEALTH
VA34449OtherOPTIMA
VA539779OtherAETNA
VA13831OtherCIGNA
VA540883363OtherVIRGINIA HEALTH NETWORK
VA898148OtherMAMSI
VA0103157OtherUNITED HEALTHCARE
VA540883363OtherPHCS
VA540883363OtherPREFERRED CARE
VA328364OtherANTHEM
VA540883363OtherFIRST HEALTH/CCN
VA540883363OtherGREAT WEST HEALTHCARE
VA5640351Medicaid
VA540883363OtherCHAMPUS-TRICARE
VA016346V27Medicare PIN
VA328364OtherANTHEM
VAVV5114AMedicare PIN
VA540883363OtherFIRST HEALTH/CCN
VAG94575Medicare UPIN
VA5640351Medicaid