=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255786760
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADAM OVADIA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2016
-----------------------------------------------------
Last Update Date | 07/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1355 S COLORADO BLVD STE 100
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80222-3358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-772-7394
-----------------------------------------------------
Fax | 860-370-4890
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 77 S ADAMS ST APT 1505
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-512-7606
-----------------------------------------------------
Fax | 860-370-4890
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | PENDING
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------