Provider Demographics
NPI:1588024947
Name:COLORADO CENTER FOR DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:COLORADO CENTER FOR DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAHLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-761-0906
Mailing Address - Street 1:7180 E ORCHARD RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1724
Mailing Address - Country:US
Mailing Address - Phone:303-761-0906
Mailing Address - Fax:303-761-0907
Practice Address - Street 1:7180 E ORCHARD RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-1724
Practice Address - Country:US
Practice Address - Phone:303-761-0906
Practice Address - Fax:303-761-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49752207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty