Provider Demographics
NPI:1417343559
Name:MARCELO, DENNIS RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:RYAN
Last Name:MARCELO
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 1:3030 N CIRCLE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1180
Mailing Address - Country:US
Mailing Address - Phone:719-228-9440
Mailing Address - Fax:
Practice Address - Street 1:3030 N CIRCLE DR STE 210
Practice Address - Street 2:
Practice Address - City:COLORADO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1180
Practice Address - Country:US
Practice Address - Phone:719-228-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0064172208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine