Provider Demographics
NPI:1851493613
Name:MARSH, EMILY STEVENS
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:STEVENS
Last Name:MARSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:S
Other - Last Name:MARSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4100 E MISSISSIPPI AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-3051
Mailing Address - Country:US
Mailing Address - Phone:303-552-9522
Mailing Address - Fax:
Practice Address - Street 1:4100 E MISSISSIPPI AVE STE 110
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-3051
Practice Address - Country:US
Practice Address - Phone:303-552-9522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36903208M00000X
CODR.0036903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01369032Medicaid
CO85288721Medicaid
COP00637685OtherRAIL ROAD MEDICARE
CO01369032Medicaid
CO803313Medicare PIN
COCO300721Medicare PIN