Provider Demographics
NPI:1083685655
Name:SZUSZCZEWICZ, EDWARD S (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:S
Last Name:SZUSZCZEWICZ
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:10099 RIDGE GATE PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124
Mailing Address - Country:US
Mailing Address - Phone:303-790-1800
Mailing Address - Fax:719-368-6870
Practice Address - Street 1:10099 RIDGE GATE PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:303-790-1800
Practice Address - Fax:719-368-6870
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COCO 40312207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO93635559Medicaid
COC523278Medicare PIN
G38113Medicare UPIN