Provider Demographics
NPI:1275852139
Name:CLARK, REBECCA ORTOLANO (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ORTOLANO
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MEGAN
Other - Last Name:ORTOLANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4954 N PALMER RD
Mailing Address - Street 2:PED HEME/ONC, BLDG 19, 4TH FLR, WALTER REED NATIONAL MI
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5630
Mailing Address - Country:US
Mailing Address - Phone:301-400-1663
Mailing Address - Fax:301-400-1662
Practice Address - Street 1:4954 N PALMER RD
Practice Address - Street 2:PED HEME/ONC, BLDG 19, 4TH FLR, WALTER REED NATIONAL MI
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-1000
Practice Address - Country:US
Practice Address - Phone:301-400-1663
Practice Address - Fax:301-400-1663
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26754208000000X, 2080P0207X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program