Healthcare Provider Details

I. General information

NPI: 1831198753
Provider Name (Legal Business Name): CHARLENE DEANNE GUGGENHEIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FOUNDERS PL SUITE 109
ASPEN CO
81611-1476
US

IV. Provider business mailing address

101 FOUNDERS PL SUITE 109
ASPEN CO
81611-1476
US

V. Phone/Fax

Practice location:
  • Phone: 970-920-0104
  • Fax: 970-920-0124
Mailing address:
  • Phone: 970-920-0104
  • Fax: 970-920-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number34356
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01343565
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: