Provider Demographics
NPI:1205036662
Name:TAYLOR, LISA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:NIEBERGALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1746 COLE BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3208
Mailing Address - Country:US
Mailing Address - Phone:303-914-8800
Mailing Address - Fax:303-716-3777
Practice Address - Street 1:1746 COLE BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3208
Practice Address - Country:US
Practice Address - Phone:303-914-8800
Practice Address - Fax:303-716-3777
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO454482085P0229X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85332216Medicaid
COP00603357Medicare PIN
COC810370Medicare PIN
COC803975Medicare PIN
COP00896274Medicare PIN
COC810331Medicare PIN
COC809549Medicare PIN
COC801369Medicare PIN
COC810330Medicare PIN