Provider Demographics
NPI:1548225022
Name:GOLUB, BURTON P (MD)
Entity Type:Individual
Prefix:DR
First Name:BURTON
Middle Name:P
Last Name:GOLUB
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 1:601 E HAMPDEN AVE
Mailing Address - Street 2:SUITE # 340
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3781
Mailing Address - Country:US
Mailing Address - Phone:303-788-5900
Mailing Address - Fax:303-788-5922
Practice Address - Street 1:601 E HAMPDEN AVE
Practice Address - Street 2:SUITE # 340
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3781
Practice Address - Country:US
Practice Address - Phone:303-788-5900
Practice Address - Fax:303-788-5922
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16139174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD28173Medicare UPIN
COCE6518Medicare PIN