Provider Demographics
NPI:1043538085
Name:ANZALONE, SUSAN PATRICE (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:PATRICE
Last Name:ANZALONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1873 S BELLAIRE ST STE 620
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4353
Mailing Address - Country:US
Mailing Address - Phone:720-870-0334
Mailing Address - Fax:831-603-0438
Practice Address - Street 1:1873 S BELLAIRE ST STE 620
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4353
Practice Address - Country:US
Practice Address - Phone:720-870-0334
Practice Address - Fax:831-603-0438
Is Sole Proprietor?:No
Enumeration Date:2010-05-15
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250618802084N0400X
CODR.00536652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17755212Medicaid
CO438126ZJUROtherMEDICARE