MEDICARE: PAOLA ANDREA ORTEGA-RODRIGUEZ 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	208000000X	Pediatrics Physician	0101258599	VA

General Provider Information

NPI Number	:	1104054345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAOLA ANDREA ORTEGA-RODRIGUEZ M.D

Provider Business Mailing Address
First Line	:	3914 MEADOWDALE BLVD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-5547
Country	:	US
Telephone Number	:	804-447-3490
Fax Number	:	804-447-3872

Provider Business Practice Location Address
First Line	:	3914 MEADOWDALE BLVD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-5547
Country	:	US
Telephone Number	:	804-447-3490
Fax Number	:	804-447-3872

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

Provider Enumeration Date	:	06/25/2009
Last Update Date	:	02/11/2017

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