Provider Demographics
NPI:1184350605
Name:ZILBERMAN, DMITRIY
Entity type:Individual
Prefix:
First Name:DMITRIY
Middle Name:
Last Name:ZILBERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 CORBETT DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-9579
Mailing Address - Country:US
Mailing Address - Phone:970-207-4857
Mailing Address - Fax:970-207-4885
Practice Address - Street 1:4601 CORBETT DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-9579
Practice Address - Country:US
Practice Address - Phone:970-207-4857
Practice Address - Fax:970-207-4885
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1653807163W00000X
COAPN.0998169-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000210853Medicaid