Provider Demographics
NPI:1932162757
Name:ORNDORFF, GEORGE R (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:ORNDORFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5615A HIGH ST W
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-3758
Mailing Address - Country:US
Mailing Address - Phone:757-484-5002
Mailing Address - Fax:757-483-9605
Practice Address - Street 1:5615A HIGH ST W
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3758
Practice Address - Country:US
Practice Address - Phone:757-484-5002
Practice Address - Fax:757-483-9605
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102831107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7000073Medicaid
VA7000073Medicaid