Provider Demographics
NPI:1598164816
Name:GALA, NEELAM KISHOR (PA-C)
Entity Type:Individual
Prefix:
First Name:NEELAM
Middle Name:KISHOR
Last Name:GALA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 E BELLEVIEW AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1629
Mailing Address - Country:US
Mailing Address - Phone:303-789-5242
Mailing Address - Fax:303-789-5264
Practice Address - Street 1:799 E HAMPDEN AVE STE 315
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2762
Practice Address - Country:US
Practice Address - Phone:303-789-5242
Practice Address - Fax:303-789-5264
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003927363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58326740Medicaid
CO58326740Medicaid