Healthcare Provider Details

I. General information

NPI: 1740629849
Provider Name (Legal Business Name): ASTER GEBREKIDAN ASMEROM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASTER E GEBREKIDAN MD

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ROCKY MOUNTAIN AVE STE 2100
LOVELAND CO
80538-9004
US

IV. Provider business mailing address

2500 ROCKY MOUNTAIN AVE STE 2100
LOVELAND CO
80538-9004
US

V. Phone/Fax

Practice location:
  • Phone: 970-203-7153
  • Fax: 970-336-1505
Mailing address:
  • Phone: 970-203-7153
  • Fax: 970-336-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDR0058930
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: