MEDICARE: ALICE EUSEBIO ORDONEZ MD

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	207Q00000X	Family Medicine Physician	0101239407	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	237850	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1518073956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE EUSEBIO ORDONEZ MD

Provider Business Mailing Address
First Line	:	2712 VIRGINIA BEACH BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-7615
Country	:	US
Telephone Number	:	757-300-1071
Fax Number	:	757-525-2953

Provider Business Practice Location Address
First Line	:	2712 VIRGINIA BEACH BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-7615
Country	:	US
Telephone Number	:	757-300-1071
Fax Number	:	757-525-2953

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	01/18/2024

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Directions to “ ALICE EUSEBIO ORDONEZ MD” Practice Location

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