Provider Demographics
NPI:1497725667
Name:ORTEGA-CARR, DEBORA A (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORA
Middle Name:A
Last Name:ORTEGA-CARR
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 1:9800 SHELBYVILLE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2992
Mailing Address - Country:US
Mailing Address - Phone:502-429-8585
Mailing Address - Fax:855-656-7325
Practice Address - Street 1:8080 RAVINES EDGE CT STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5424
Practice Address - Country:US
Practice Address - Phone:614-846-5944
Practice Address - Fax:855-656-7325
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-6944207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0985840Medicaid
OHOR0765751Medicare PIN
OHE78111Medicare UPIN