Provider Demographics
NPI:1891018420
Name:JOSEPH AGNELLO MD PC
Entity Type:Organization
Organization Name:JOSEPH AGNELLO MD PC
Other - Org Name:BODYLOGICMD OF DENVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:AGNELLO
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:877-445-9052
Mailing Address - Street 1:3130 SANFORD CIR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4928
Mailing Address - Country:US
Mailing Address - Phone:877-445-9052
Mailing Address - Fax:877-445-9053
Practice Address - Street 1:1780 S BELLAIRE ST
Practice Address - Street 2:SUITE 230
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4307
Practice Address - Country:US
Practice Address - Phone:877-445-9052
Practice Address - Fax:877-445-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36493174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty