Provider Demographics
NPI:1811998289
Name:NATHANSON, MARK H (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:NATHANSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1550 S POTOMAC ST
Mailing Address - Street 2:STE 370
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5455
Mailing Address - Country:US
Mailing Address - Phone:303-369-1080
Mailing Address - Fax:303-750-4913
Practice Address - Street 1:1550 S POTOMAC ST
Practice Address - Street 2:STE 370
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5455
Practice Address - Country:US
Practice Address - Phone:303-369-1080
Practice Address - Fax:303-750-4913
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO32517207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84087252106OtherPACIFICARE/SECURE HORIZON
CO32349OtherANTHEM BLUE CROSS
COP00075124OtherRAILROAD MEDICARE
CO84087252106OtherPACIFICARE/SECURE HORIZON
COF84763Medicare UPIN