Provider Demographics
NPI:1487630760
Name:ROSSI, LORI C (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:C
Last Name:ROSSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:C
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5000 S BEELER ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1314
Mailing Address - Country:US
Mailing Address - Phone:303-771-4777
Mailing Address - Fax:
Practice Address - Street 1:5000 S BEELER ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1314
Practice Address - Country:US
Practice Address - Phone:303-771-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31231208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01312313Medicaid
CO01312313Medicaid
COCO40854Medicare UPIN
COF02779Medicare UPIN
COCOB4545Medicare PIN