Provider Demographics
NPI:1356445605
Name:CHERTKOVA, ELENA L (MD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:L
Last Name:CHERTKOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:L
Other - Last Name:TCHERTKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 W 144TH AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80023-9326
Mailing Address - Country:US
Mailing Address - Phone:303-430-2640
Mailing Address - Fax:303-430-2625
Practice Address - Street 1:500 W 144TH AVE STE 140
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80023-9326
Practice Address - Country:US
Practice Address - Phone:303-430-2640
Practice Address - Fax:303-430-2625
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61881538Medicaid