Provider Demographics
NPI:1184800179
Name:VANDNA JERATH
Entity type:Organization
Organization Name:VANDNA JERATH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:SANDRA
Authorized Official - Last Name:PERINN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:303-427-5010
Mailing Address - Street 1:8300 ALCOTT ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-4008
Mailing Address - Country:US
Mailing Address - Phone:303-427-5010
Mailing Address - Fax:303-427-0268
Practice Address - Street 1:8300 ALCOTT ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-4008
Practice Address - Country:US
Practice Address - Phone:303-427-5010
Practice Address - Fax:303-427-0268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36626207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07751061Medicaid
CO76018Medicare PIN
CO07751061Medicaid