1124193453 NPI number — DAMON J NEGRI

Table of content: DAMON J NEGRI (NPI 1124193453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124193453 NPI number — DAMON J NEGRI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEGRI
Provider First Name:
DAMON
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEGRI
Provider Other First Name:
DAMON
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1124193453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 173894
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80217-3894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-306-7783
Provider Business Mailing Address Fax Number:
303-306-7753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4747 ARAPAHOE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80303-1133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-306-7783
Provider Business Practice Location Address Fax Number:
303-306-7753
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  8321 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: DR.0025479 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0194671 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 275270099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30007778 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 930050636 . This is a "RAILROAD" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0105112Y0NH07 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0105112Y0NH08 . This is a "BCBS OF NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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