Provider Demographics
NPI:1326455171
Name:LAWRENCE E ADLER MD PC
Entity Type:Organization
Organization Name:LAWRENCE E ADLER MD PC
Other - Org Name:LAWRENCE E ADLER MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-993-5288
Mailing Address - Street 1:4155 E JEWELL AVE
Mailing Address - Street 2:SUITE 1004
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4504
Mailing Address - Country:US
Mailing Address - Phone:303-993-5288
Mailing Address - Fax:866-281-5416
Practice Address - Street 1:4155 E JEWELL AVE
Practice Address - Street 2:SUITE 1004
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4504
Practice Address - Country:US
Practice Address - Phone:303-993-5288
Practice Address - Fax:866-281-5416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20894302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA102715OtherMEDICARE PTAN
$$$$$$$$$OtherSSN
1972577641OtherNPI