Provider Demographics
NPI:1386656601
Name:ATAGI, TANYA AYA (MD)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:AYA
Last Name:ATAGI
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 1:10099 RIDGEGATE PKWY
Mailing Address - Street 2:SUITE 430
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5531
Mailing Address - Country:US
Mailing Address - Phone:303-327-7300
Mailing Address - Fax:303-327-7304
Practice Address - Street 1:10099 RIDGEGATE PKWY
Practice Address - Street 2:SUITE 430
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5531
Practice Address - Country:US
Practice Address - Phone:303-327-7300
Practice Address - Fax:303-327-7304
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38153174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59036541Medicaid
CO59036541Medicaid