MEDICARE: RODRIGO C HURTADO 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	207K00000X	Allergy & Immunology Physician	0101023928	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036036	OTHER	VA	ANTHEM
2	4086177	OTHER	VA	AETNA
3	2156	OTHER	VA	B/C B/S GROUP #
4	0004	OTHER	VA	B/C B/S INDIVIDUAL #
5	246822	OTHER	VA	MAMSI

General Provider Information

NPI Number	:	1134122161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODRIGO C HURTADO M.D.

Provider Business Mailing Address
First Line	:	3450 N BEAUREGARD ST
Second Line	:	STE 1
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1200
Country	:	US
Telephone Number	:	703-820-7000
Fax Number	:	703-931-0059

Provider Business Practice Location Address
First Line	:	3450 N BEAUREGARD ST
Second Line	:	STE 1
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1200
Country	:	US
Telephone Number	:	703-820-7000
Fax Number	:	703-931-0059

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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Directions to “ RODRIGO C HURTADO M.D.” Practice Location

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