Provider Demographics
NPI:1811994783
Name:SCANLAN, AMY E (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:SCANLAN
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 1:2695 ROCKY MOUNTAIN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9074
Mailing Address - Country:US
Mailing Address - Phone:970-624-4420
Mailing Address - Fax:
Practice Address - Street 1:16990 VILLAGE CENTER DR E
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9376
Practice Address - Country:US
Practice Address - Phone:720-516-9191
Practice Address - Fax:720-516-9192
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0036374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01363746Medicaid
CON1854Medicare PIN
G93536Medicare UPIN