Provider Demographics
NPI:1043208259
Name:GUADAGNOLI, MARK D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:GUADAGNOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2500 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9004
Mailing Address - Country:US
Mailing Address - Phone:970-624-1800
Mailing Address - Fax:970-624-1891
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE
Practice Address - Street 2:STE 100
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:970-624-1800
Practice Address - Fax:970-624-1891
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2022-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO295902086S0129X, 208G00000X
WY5495A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY111738600Medicaid
CO01295906Medicaid
NE1043208259Medicaid
COP00970371OtherRAILROAD MEDICARE
COCOA102987Medicare PIN
COP00970371OtherRAILROAD MEDICARE