1225026099 NPI number — DR. MARYLIDA CARLINE-GILKINSON M.D.

Table of content: DR. MARYLIDA CARLINE-GILKINSON M.D. (NPI 1225026099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225026099 NPI number — DR. MARYLIDA CARLINE-GILKINSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARLINE-GILKINSON
Provider First Name:
MARYLIDA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARLINE
Provider Other First Name:
MARYLIDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1225026099
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1236 E ELIZABETH ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80524-4000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-224-2985
Provider Business Mailing Address Fax Number:
970-472-9381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1236 E ELIZABETH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80524-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-224-2985
Provider Business Practice Location Address Fax Number:
970-472-9381
Provider Enumeration Date:
10/06/2005

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: 207L00000X , with the licence number:  H6095 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 6722A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: DR.0031232 , 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: 104576800 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01312321 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0240560 . This is a "WORKMANS COMP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".