Provider Demographics
NPI:1124040555
Name:ORTIZ, DAISY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAISY
Middle Name:
Last Name:ORTIZ
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 1:700 W GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-4273
Mailing Address - Country:US
Mailing Address - Phone:610-630-6888
Mailing Address - Fax:610-630-6940
Practice Address - Street 1:700 W GERMANTOWN PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4273
Practice Address - Country:US
Practice Address - Phone:610-630-6888
Practice Address - Fax:610-630-6940
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058310L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018186940001Medicaid
PAG56298Medicare UPIN
PA042164Medicare ID - Type Unspecified