MEDICARE: DR. KELLY CHRISTINE ORTIZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	MD465344	PA

General Provider Information

NPI Number	:	1134502479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY CHRISTINE ORTIZ M.D.

Provider Business Mailing Address
First Line	:	3509 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-4105
Country	:	US
Telephone Number	:	215-829-3264
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 SPRUCE ST BSMT WEST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-4022
Country	:	US
Telephone Number	:	215-829-3264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2015
Last Update Date	:	01/22/2026

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