Provider Demographics
NPI:1548228059
Name:ORTENZIO, THOMAS J (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:ORTENZIO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1861 POWDER MILL RD
Mailing Address - Street 2:ATTN MSO
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4723
Mailing Address - Country:US
Mailing Address - Phone:717-718-2000
Mailing Address - Fax:717-741-9867
Practice Address - Street 1:3230 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-3030
Practice Address - Country:US
Practice Address - Phone:717-755-0722
Practice Address - Fax:717-757-7255
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002766L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T29597Medicare UPIN
146191J0ZMedicare ID - Type Unspecified