Provider Demographics
NPI:1447205224
Name:WASHINGTON, REGINALD LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:LOUIS
Last Name:WASHINGTON
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 1:10099 RIDGEGATE PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5531
Mailing Address - Country:US
Mailing Address - Phone:303-860-9933
Mailing Address - Fax:
Practice Address - Street 1:10099 RIDGEGATE PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5531
Practice Address - Country:US
Practice Address - Phone:303-860-9933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO203582080P0202X
WY3421-A2080P0202X
NE210222080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01203587Medicaid
CO95124Medicare ID - Type Unspecified
CO01203587Medicaid