Provider Demographics
NPI:1922013739
Name:DAUGHARTY, MAIRE C (MD)
Entity Type:Individual
Prefix:DR
First Name:MAIRE
Middle Name:C
Last Name:DAUGHARTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80001-0668
Mailing Address - Country:US
Mailing Address - Phone:303-422-9438
Mailing Address - Fax:303-422-9474
Practice Address - Street 1:1819 DENVER WEST DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3118
Practice Address - Country:US
Practice Address - Phone:303-422-9438
Practice Address - Fax:303-422-9474
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75708207L00000X
CO46902207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08735379Medicaid
H71332Medicare UPIN