Provider Demographics
NPI:1699865725
Name:STIFF, MINNIE Z (MD)
Entity type:Individual
Prefix:MRS
First Name:MINNIE
Middle Name:Z
Last Name:STIFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 HARTFORD RD STE C
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6600
Mailing Address - Country:US
Mailing Address - Phone:757-827-1661
Mailing Address - Fax:757-827-8673
Practice Address - Street 1:2110 HARTFORD RD STE C
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6600
Practice Address - Country:US
Practice Address - Phone:757-827-1661
Practice Address - Fax:757-827-8673
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026001208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6716555Medicaid
VA6716555Medicaid