Provider Demographics
NPI:1033273446
Name:ORTOLANO, ALEXANDER M (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:M
Last Name:ORTOLANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 STEVENS DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3535
Mailing Address - Country:US
Mailing Address - Phone:509-946-7900
Mailing Address - Fax:509-946-7944
Practice Address - Street 1:900 STEVENS DR
Practice Address - Street 2:SUITE 203
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3535
Practice Address - Country:US
Practice Address - Phone:509-946-7900
Practice Address - Fax:509-946-7944
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043823174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8418352Medicaid
WAG8866803Medicare PIN
WAI29507Medicare UPIN