Provider Demographics
NPI:1205813839
Name:DEMACOPOULOS, NICOLA D (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLA
Middle Name:D
Last Name:DEMACOPOULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4674 SNOW MESA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8615
Mailing Address - Country:US
Mailing Address - Phone:970-482-3712
Mailing Address - Fax:970-266-4190
Practice Address - Street 1:4674 SNOW MESA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8615
Practice Address - Country:US
Practice Address - Phone:970-482-3712
Practice Address - Fax:970-482-4057
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO49240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00944697OtherMEDICARE RAILROAD CARRIER PTAN
CO81139004Medicaid
COCOA104897Medicare PIN
COP00944697OtherMEDICARE RAILROAD CARRIER PTAN