Healthcare Provider Details

I. General information

NPI: 1003312778
Provider Name (Legal Business Name): RICHARD STEVEN ORTEGON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 KANE ST
WEST HARTFORD CT
06119-2110
US

IV. Provider business mailing address

2213 ELBA ST
DURHAM NC
27705-3934
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-6700
  • Fax: 860-679-6736
Mailing address:
  • Phone: 919-684-0119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2022-01951
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number82577
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: