Provider Demographics
NPI:1710942339
Name:BURSTEN, MARIAN S (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:S
Last Name:BURSTEN
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8702
Mailing Address - Country:US
Mailing Address - Phone:970-624-4443
Mailing Address - Fax:
Practice Address - Street 1:5050 POWDERHOUSE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4800
Practice Address - Country:US
Practice Address - Phone:970-634-1311
Practice Address - Fax:970-634-1271
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42461207Q00000X
WY7656A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY124242300Medicaid
CO800951Medicare ID - Type Unspecified
WYW21218Medicare PIN
WY124242300Medicaid
WYW24631Medicare PIN