Healthcare Provider Details

I. General information

NPI: 1376502617
Provider Name (Legal Business Name): MAURICIO ORREGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 OLD YORK ROAD KLEIN BLDG STE 509
PHILADELPHIA PA
19141
US

IV. Provider business mailing address

101 EAST OLNEY AVENUE 400
PHILADELPHIA PA
19120
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-4985
  • Fax: 215-456-8058
Mailing address:
  • Phone: 215-456-7000
  • Fax: 215-254-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberDR.0069630
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberDR.0069630
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD427295
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: