Provider Demographics
NPI:1134122161
Name:HURTADO, RODRIGO C (MD)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:C
Last Name:HURTADO
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 1:3450 N BEAUREGARD ST
Mailing Address - Street 2:STE 1
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1200
Mailing Address - Country:US
Mailing Address - Phone:703-820-7000
Mailing Address - Fax:703-931-0059
Practice Address - Street 1:3450 N BEAUREGARD ST
Practice Address - Street 2:STE 1
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1200
Practice Address - Country:US
Practice Address - Phone:703-820-7000
Practice Address - Fax:703-931-0059
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023928207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA036036OtherANTHEM
VA4086177OtherAETNA
VA2156OtherB/C B/S GROUP #
VA0004OtherB/C B/S INDIVIDUAL #
VA246822OtherMAMSI
VA4086177OtherAETNA
VA408722Medicare ID - Type UnspecifiedGROUP #