Provider Demographics
NPI:1801870563
Name:DICKERSON, MAUREEN (MD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HEALTH PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-4644
Mailing Address - Country:US
Mailing Address - Phone:303-666-2720
Mailing Address - Fax:
Practice Address - Street 1:80 HEALTH PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-4644
Practice Address - Country:US
Practice Address - Phone:303-666-2720
Practice Address - Fax:303-666-2734
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33429208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO493848Medicare ID - Type Unspecified
H81419Medicare UPIN