MEDICARE: THOMAS DALSASO JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	37351	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548245525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS DALSASO JR. MD

Provider Business Mailing Address
First Line	:	6 ELM AVE STE 150
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3131
Country	:	US
Telephone Number	:	970-663-2742
Fax Number	:	970-342-2093

Provider Business Practice Location Address
First Line	:	6 ELM AVE STE 150
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3131
Country	:	US
Telephone Number	:	719-632-5020
Fax Number	:	719-520-5488

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	11/05/2020

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