Healthcare Provider Details

I. General information

NPI: 1821134644
Provider Name (Legal Business Name): ADAM COURCHAINE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 E DRY CREEK RD STE G101
CENTENNIAL CO
80112-2574
US

IV. Provider business mailing address

600 W COUNTY LINE RD APT 31-202
HIGHLANDS RANCH CO
80129-6512
US

V. Phone/Fax

Practice location:
  • Phone: 720-647-7460
  • Fax: 720-684-5766
Mailing address:
  • Phone: 774-219-9311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4256
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAP2155
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: