Provider Demographics
NPI:1609417526
Name:ORTOLANI, ANDREA MAUREEN
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MAUREEN
Last Name:ORTOLANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 PUBLIC LANDING RD
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21863-2453
Mailing Address - Country:US
Mailing Address - Phone:410-632-1100
Mailing Address - Fax:410-632-2476
Practice Address - Street 1:113 AQUEDUCT CT
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-3272
Practice Address - Country:US
Practice Address - Phone:443-752-1356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator