Provider Demographics
NPI:1346226602
Name:MARK A NORDEN M.D.,PC
Entity Type:Organization
Organization Name:MARK A NORDEN M.D.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:NORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-713-1300
Mailing Address - Street 1:PO BOX 5719
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-5719
Mailing Address - Country:US
Mailing Address - Phone:303-713-1300
Mailing Address - Fax:
Practice Address - Street 1:340 PEAK ONE DRIVE
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:303-885-4673
Practice Address - Fax:405-948-6507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41039207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO77309219Medicaid
CO77309219Medicaid
COH30670Medicare UPIN
DF1969Medicare PIN