Provider Demographics
NPI:1972659571
Name:MANCHON, ADAM D (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:D
Last Name:MANCHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SHERMAN ST
Mailing Address - Street 2:STE 510
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-4400
Mailing Address - Country:US
Mailing Address - Phone:303-377-6825
Mailing Address - Fax:303-780-0787
Practice Address - Street 1:4380 S SYRACUSE ST STE 120
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-3094
Practice Address - Country:US
Practice Address - Phone:303-422-9438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45435207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10108327Medicaid
MT3506685Medicaid
KS200428570AMedicaid
NE84113438513Medicaid
WY1972659571Medicaid
NM92754058Medicaid
MT3506685Medicaid
NM92754058Medicaid