Provider Demographics
NPI:1326198169
Name:DIAS, SUSAN PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:PATRICIA
Last Name:DIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 JERSEY STREET
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220
Mailing Address - Country:US
Mailing Address - Phone:303-331-0539
Mailing Address - Fax:
Practice Address - Street 1:1601 E 19TH AVENUE
Practice Address - Street 2:SUITE # 3650
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218
Practice Address - Country:US
Practice Address - Phone:303-831-4774
Practice Address - Fax:303-839-7750
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35677174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01356773Medicaid
COE6558Medicare ID - Type Unspecified
COF22789Medicare UPIN