Provider Demographics
NPI:1891737300
Name:OLSOVSKY, MARY R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:R
Last Name:OLSOVSKY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8890 N UNION BLVD
Mailing Address - Street 2:STE 160
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7799
Mailing Address - Country:US
Mailing Address - Phone:719-635-7172
Mailing Address - Fax:719-444-3759
Practice Address - Street 1:1400 E BOULDER ST
Practice Address - Street 2:SUITE 700
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5533
Practice Address - Country:US
Practice Address - Phone:719-635-7172
Practice Address - Fax:719-444-3759
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2013-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO37736207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03475077Medicaid
COCV4678Medicare PIN
COC5154Medicare PIN
CO263655YLB8Medicare PIN
COC155908Medicare PIN
COF79636Medicare UPIN