Provider Demographics
NPI:1942293485
Name:MAO, JIE (MD)
Entity Type:Individual
Prefix:
First Name:JIE
Middle Name:
Last Name:MAO
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 1:42 GARDEN CTR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1730
Mailing Address - Country:US
Mailing Address - Phone:303-465-0401
Mailing Address - Fax:303-438-1351
Practice Address - Street 1:1100 BALSAM AVE
Practice Address - Street 2:RADIOLOGY
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3404
Practice Address - Country:US
Practice Address - Phone:303-440-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO417952085R0202X
CODR.00417952085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96073721Medicaid
COC509558Medicare PIN
COH93751Medicare UPIN
COP00067800Medicare ID - Type UnspecifiedBRI RAILROAD
COP00067800Medicare ID - Type UnspecifiedBRI RAILROAD
COH93751Medicare UPIN