Provider Demographics
NPI:1457572695
Name:PARIKH, MANSI B (MD)
Entity Type:Individual
Prefix:
First Name:MANSI
Middle Name:B
Last Name:PARIKH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 DRY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-6499
Mailing Address - Country:US
Mailing Address - Phone:303-772-3300
Mailing Address - Fax:303-682-3380
Practice Address - Street 1:1400 DRY CREEK DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-6499
Practice Address - Country:US
Practice Address - Phone:303-772-3300
Practice Address - Fax:303-682-3380
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-050274207W00000X
IA37734207W00000X
WAMD 60096106207W00000X
OR71862207W00000X
CODR.0061896207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI0923053Medicare PIN
IAP00655699Medicare PIN