Provider Demographics
NPI:1124193453
Name:NEGRI, DAMON J
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:J
Last Name:NEGRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DAMON
Other - Middle Name:J
Other - Last Name:NEGRI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 173894
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-3894
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:4747 ARAPAHOE AVENUE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1133
Practice Address - Country:US
Practice Address - Phone:303-306-7783
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8321207P00000X
CODR.0025479207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0194671Medicaid
ME275270099Medicaid
NH30007778Medicaid
NH930050636OtherRAILROAD
NH0105112Y0NH07OtherANTHEM
NH0105112Y0NH08OtherBCBS OF NH
E17477Medicare UPIN
NHRE1214Medicare ID - Type Unspecified
NHPX1463Medicare PIN