Provider Demographics
NPI:1346287141
Name:LOSASSO, LEONARD (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:LOSASSO
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 1:1411 S POTOMAC ST STE 230
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4525
Mailing Address - Country:US
Mailing Address - Phone:303-353-9531
Mailing Address - Fax:303-745-7987
Practice Address - Street 1:1421 S POTOMAC ST STE 240
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4512
Practice Address - Country:US
Practice Address - Phone:303-695-2822
Practice Address - Fax:303-368-2036
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20360207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59726059OtherMEDICAID GROUP NUMBER
CO810212OtherMEDICARE GROUP NUMBER
CO04707048Medicaid
CO01203603Medicare ID - Type UnspecifiedMEDICARE
COC810233Medicare PIN
CO810233Medicare PIN
COD23769Medicare UPIN