Provider Demographics
NPI:1245318419
Name:NATHAN S PERSOFF, MD, PC
Entity type:Organization
Organization Name:NATHAN S PERSOFF, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PERSOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-788-6490
Mailing Address - Street 1:701 E HAMPDEN AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2736
Mailing Address - Country:US
Mailing Address - Phone:303-788-6490
Mailing Address - Fax:303-788-5451
Practice Address - Street 1:701 E HAMPDEN AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2736
Practice Address - Country:US
Practice Address - Phone:303-788-6490
Practice Address - Fax:303-788-5451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37390207Q00000X
CO18924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H45280Medicare UPIN
C441358Medicare ID - Type Unspecified
D23523Medicare UPIN