Healthcare Provider Details

I. General information

NPI: 1508842238
Provider Name (Legal Business Name): MEGHAN B GUERIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 W 121ST PL
BROOMFIELD CO
80020-7921
US

IV. Provider business mailing address

3830 W 121ST PL
BROOMFIELD CO
80020-7921
US

V. Phone/Fax

Practice location:
  • Phone: 303-410-8041
  • Fax: 303-410-8044
Mailing address:
  • Phone: 303-410-8041
  • Fax: 303-410-8044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37146
License Number StateCO

VII. Legacy identifiers

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

# 1
Identifier01371467
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: