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NPI Code Detail

MEDICARE: DR. RANDI M KODROFF D.O.

MEDICARE: DR. RANDI M KODROFF D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician0102203317VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831155373
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDI M KODROFF D.O.
Provider Business Mailing Address
First Line : 1005 N GLEBE RD
Second Line : SUITE 400
City : ARLINGTON
State : VA
Zip : 22201-5718
Country : US
Telephone Number : 571-492-3045
Fax Number : 571-492-3046
Provider Business Practice Location Address
First Line : 1005 N GLEBE RD
Second Line : SUITE 400
City : ARLINGTON
State : VA
Zip : 22201-5718
Country : US
Telephone Number : 571-492-3045
Fax Number : 571-492-3046
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2006
Last Update Date : 03/07/2023

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