Provider Demographics
NPI:1275727562
Name:LEONARD J LOSASSO MD PC
Entity Type:Organization
Organization Name:LEONARD J LOSASSO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOSASSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-337-5550
Mailing Address - Street 1:1455 S POTOMAC ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4504
Mailing Address - Country:US
Mailing Address - Phone:303-337-5550
Mailing Address - Fax:
Practice Address - Street 1:1455 S POTOMAC ST
Practice Address - Street 2:SUITE 304
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4504
Practice Address - Country:US
Practice Address - Phone:303-337-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC70704Medicare PIN