Provider Demographics
NPI:1235428137
Name:MYRNA M. ORTEGA, M.D., P.A
Entity Type:Organization
Organization Name:MYRNA M. ORTEGA, M.D., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:410-573-9450
Mailing Address - Street 1:2003 MEDICAL PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7992
Mailing Address - Country:US
Mailing Address - Phone:410-573-9450
Mailing Address - Fax:410-973-9439
Practice Address - Street 1:2003 MEDICAL PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7992
Practice Address - Country:US
Practice Address - Phone:410-573-9450
Practice Address - Fax:410-973-9439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD36143207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD208921100Medicaid
MDD18074Medicare UPIN