Provider Demographics
NPI:1275738510
Name:CORNERSTONE PEDIATRICS ASSOCIATES
Entity Type:Organization
Organization Name:CORNERSTONE PEDIATRICS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CARLIN
Authorized Official - Last Name:BUCKNAM
Authorized Official - Suffix:
Authorized Official - Credentials:M, D
Authorized Official - Phone:303-673-9030
Mailing Address - Street 1:90 HEALTH PARK DR STE 160
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9742
Mailing Address - Country:US
Mailing Address - Phone:303-673-9030
Mailing Address - Fax:303-604-1095
Practice Address - Street 1:90 HEALTH PARK DR STE 160
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9742
Practice Address - Country:US
Practice Address - Phone:303-673-9030
Practice Address - Fax:303-604-1095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01313659Medicaid
COF54658Medicare UPIN