Provider Demographics
NPI:1336116474
Name:ORTIZ, MADELEINE ANA (MD)
Entity Type:Individual
Prefix:DR
First Name:MADELEINE
Middle Name:ANA
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 1:2525 SOUTHEAST BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-3464
Mailing Address - Country:US
Mailing Address - Phone:330-332-2710
Mailing Address - Fax:330-332-2725
Practice Address - Street 1:1076 E STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2228
Practice Address - Country:US
Practice Address - Phone:330-332-2710
Practice Address - Fax:330-332-2725
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-059371208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0897981Medicaid