Healthcare Provider Details

I. General information

NPI: 1154564797
Provider Name (Legal Business Name): MARC AARON PASSO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 W 2ND PL
LAKEWOOD CO
80228-1527
US

IV. Provider business mailing address

PO BOX 5788
DENVER CO
80217-5788
US

V. Phone/Fax

Practice location:
  • Phone: 721-321-4161
  • Fax: 303-321-4165
Mailing address:
  • Phone: 303-202-1280
  • Fax: 303-202-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number237289
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License NumberDR.0051945
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: