Provider Demographics
NPI:1376621698
Name:VONSTADE, ELEANOR (MD)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:VONSTADE
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 1:1450 E VALLEY RD
Mailing Address - Street 2:STE 201
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8304
Mailing Address - Country:US
Mailing Address - Phone:970-927-1757
Mailing Address - Fax:
Practice Address - Street 1:100 E MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1780
Practice Address - Country:US
Practice Address - Phone:970-925-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2006-0631207X00000X
NE34942207X00000X
CO43708207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM001Q09OtherBCBS NM
NM29636256Medicaid
202011781OtherPRESBYTERIAN HEALTH PLANS
10029070OtherLOVELACE
000810808202OtherPHCS
2643467OtherUHC
QMYPR0073325OtherMOLINA
144420Medicare UPIN
2643467OtherUHC