Provider Demographics
NPI:1336300458
Name:HAMBURGER, NATHAN (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:HAMBURGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 19TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1459
Mailing Address - Country:US
Mailing Address - Phone:303-293-9311
Mailing Address - Fax:303-293-8028
Practice Address - Street 1:1255 19TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1459
Practice Address - Country:US
Practice Address - Phone:303-293-9311
Practice Address - Fax:303-293-8028
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092703207R00000X
CO51040207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA106669OtherMEDICARE PTAN
CO18877559Medicaid