Provider Demographics
NPI:1679548325
Name:ORTEGA, MARIO R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:R
Last Name:ORTEGA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:10901 CONNECTICUT AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1645
Mailing Address - Country:US
Mailing Address - Phone:240-290-1041
Mailing Address - Fax:240-290-1045
Practice Address - Street 1:10901 CONNECTICUT AVE
Practice Address - Street 2:STE. 100
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1645
Practice Address - Country:US
Practice Address - Phone:240-290-1041
Practice Address - Fax:240-290-1045
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-02-17
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Provider Licenses
StateLicense IDTaxonomies
MDD14533208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD213221400Medicaid