1851303002 NPI number — DR. LESLIE GAMACHE MD

Table of content: DR. LESLIE GAMACHE MD (NPI 1851303002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851303002 NPI number — DR. LESLIE GAMACHE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAMACHE
Provider First Name:
LESLIE
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
SALBENBLATT
Provider Other First Name:
LESLIE
Provider Other Middle Name:
CLAIRE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851303002
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4900 S MONACO ST
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80237-3486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-228-1240
Provider Business Mailing Address Fax Number:
303-228-1250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 E 19TH AVE STE 4350
Provider Second Line Business Practice Location Address:
SUITE 454
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80218-1253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-228-1240
Provider Business Practice Location Address Fax Number:
303-228-1250
Provider Enumeration Date:
08/13/2006

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: 207RE0101X , with the licence number:  44771 , 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: 10025716100 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1851303002 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200739320A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50858360 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89438825 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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