Provider Demographics
NPI:1376603282
Name:AMBARDEKAR, ERIN JEAN (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:JEAN
Last Name:AMBARDEKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 MARION ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1514
Mailing Address - Country:US
Mailing Address - Phone:303-830-7337
Mailing Address - Fax:
Practice Address - Street 1:1625 MARION ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1514
Practice Address - Country:US
Practice Address - Phone:303-830-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44313208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics