Provider Demographics
NPI:1831155373
Name:KODROFF, RANDI M (DO)
Entity type:Individual
Prefix:DR
First Name:RANDI
Middle Name:M
Last Name:KODROFF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1005 N GLEBE RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-5718
Mailing Address - Country:US
Mailing Address - Phone:571-492-3045
Mailing Address - Fax:571-492-3046
Practice Address - Street 1:1005 N GLEBE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-5718
Practice Address - Country:US
Practice Address - Phone:571-492-3045
Practice Address - Fax:571-492-3046
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102203317207Q00000X
FLOS11464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4819Medicaid
BK1199187OtherDEA
SC8938Medicare PIN
SCE73018Medicare UPIN