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General NPI Number Information
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NPI Number | 1144364936
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Entity Type | Individual
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Provider Name | MARK P DE MARIE MD
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Gender | Male
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 1375 E 20TH AVE
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City | DENVER
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State | CO
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Zip | 80205-5423
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Country | US
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Telephone | 303-743-5855
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Fax |
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Provider Business Mailing Address
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Address Line | 1375 E 20TH AVE
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City | DENVER
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State | CO
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Zip | 80205-5422
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Country | US
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Telephone | 303-369-0710
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 28546
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License Number State | CO
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