1598151011 NPI number — ALISON HALPERN MUNGO MD

Table of content: ALISON HALPERN MUNGO MD (NPI 1598151011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598151011 NPI number — ALISON HALPERN MUNGO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNGO
Provider First Name:
ALISON
Provider Middle Name:
HALPERN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598151011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13001 E 17TH PL
Provider Second Line Business Mailing Address:
U COLORADO SOM GME
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-724-2682
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13001 E 17TH PL
Provider Second Line Business Practice Location Address:
U COLORADO SOM GME
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-724-2682
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2015

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: UNKNOWN , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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