Provider Demographics
NPI:1871838995
Name:VANDERHAMM, JONATHAN P
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:VANDERHAMM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 INTERLOCKEN BLVD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3477
Mailing Address - Country:US
Mailing Address - Phone:303-339-1499
Mailing Address - Fax:303-339-1498
Practice Address - Street 1:350 INTERLOCKEN BLVD
Practice Address - Street 2:SUITE 360
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-3477
Practice Address - Country:US
Practice Address - Phone:303-339-1499
Practice Address - Fax:303-339-1498
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic