Healthcare Provider Details

I. General information

NPI: 1396891974
Provider Name (Legal Business Name): NATHAN J SUSNOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W SOUTH BOULDER RD STE 200
LAFAYETTE CO
80026-2088
US

IV. Provider business mailing address

382 S ARTHUR AVE
LOUISVILLE CO
80027-3094
US

V. Phone/Fax

Practice location:
  • Phone: 720-932-7719
  • Fax: 720-890-0364
Mailing address:
  • Phone: 303-604-5000
  • Fax: 720-890-0364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberDR.0054243
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberDR.0054243
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: