Provider Demographics
NPI:1639279763
Name:MATESKON, CHARLES A (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:MATESKON
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 1:7951 E MAPLEWOOD AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4726
Mailing Address - Country:US
Mailing Address - Phone:303-930-7800
Mailing Address - Fax:303-930-7860
Practice Address - Street 1:10103 RIDGEGATE PKWY STE G01
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5521
Practice Address - Country:US
Practice Address - Phone:720-225-4200
Practice Address - Fax:720-225-4208
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO274222085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01274224Medicaid
CO01274224Medicaid