Provider Demographics
NPI:1144222373
Name:FAINI, MARY E (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:FAINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 MOUNTAIN VIEW AVE
Mailing Address - Street 2:STE 540
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3183
Mailing Address - Country:US
Mailing Address - Phone:303-772-5578
Mailing Address - Fax:303-772-8207
Practice Address - Street 1:1309 SUNSET ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3215
Practice Address - Country:US
Practice Address - Phone:303-772-5578
Practice Address - Fax:303-772-8207
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01334333Medicaid
CO01334333Medicaid
COF99818Medicare UPIN