Provider Demographics
NPI:1477711901
Name:RADAIDEH, SOFYAN MORSHED TALEB (MD)
Entity Type:Individual
Prefix:
First Name:SOFYAN
Middle Name:MORSHED TALEB
Last Name:RADAIDEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7951 E MAPLEWOOD AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4726
Mailing Address - Country:US
Mailing Address - Phone:303-930-7800
Mailing Address - Fax:303-930-7860
Practice Address - Street 1:3676 PARKER BLVD STE 350
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2213
Practice Address - Country:US
Practice Address - Phone:719-296-6000
Practice Address - Fax:719-545-1146
Is Sole Proprietor?:No
Enumeration Date:2008-05-31
Last Update Date:2013-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO49587207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37557874Medicaid
COCOAAA0302Medicare PIN