Provider Demographics
NPI:1134245319
Name:GREENSLADE, ROSEMARY A (MD)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:A
Last Name:GREENSLADE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3586
Mailing Address - Country:US
Mailing Address - Phone:303-440-3000
Mailing Address - Fax:
Practice Address - Street 1:2750 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3586
Practice Address - Country:US
Practice Address - Phone:303-440-3200
Practice Address - Fax:303-440-3232
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34314207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOAAA3698Medicare PIN