Provider Demographics
NPI:1598515066
Name:D'AMBROSIO, NICHOLAS THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:THOMAS
Last Name:D'AMBROSIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 YATES ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2518
Mailing Address - Country:US
Mailing Address - Phone:267-907-3136
Mailing Address - Fax:
Practice Address - Street 1:2551 W 84TH AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3807
Practice Address - Country:US
Practice Address - Phone:303-430-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000000000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty