Provider Demographics
NPI:1356340467
Name:WASSERMAN, MARC Y (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:Y
Last Name:WASSERMAN
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 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:720-274-0064
Practice Address - Street 1:8155 PINEY RIVER AVE STE 100
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80125-8729
Practice Address - Country:US
Practice Address - Phone:303-265-3390
Practice Address - Fax:720-274-0064
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110646174400000X
AZ378262084N0400X
CODR.00507782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ305105Medicaid
AZZ120272Medicare PIN
AZ305105Medicaid
ILI29062Medicare UPIN