Healthcare Provider Details

I. General information

NPI: 1487636775
Provider Name (Legal Business Name): BRAD A MARDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 RAMPART WAY STE 300B
DENVER CO
80230-6451
US

IV. Provider business mailing address

20 S TRENTON ST
DENVER CO
80230-6993
US

V. Phone/Fax

Practice location:
  • Phone: 303-327-4700
  • Fax: 303-327-4711
Mailing address:
  • Phone: 303-909-2256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number41606
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: