MEDICARE: DR. MARK D GUADAGNOLI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	29590	CO
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	5495A	WY
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	29590	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00970371	OTHER	CO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043208259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK D GUADAGNOLI M.D.

Provider Business Mailing Address
First Line	:	2500 ROCKY MOUNTAIN AVE
Second Line	:	SUITE 100
City	:	LOVELAND
State	:	CO
Zip	:	80538-9004
Country	:	US
Telephone Number	:	970-624-1800
Fax Number	:	970-624-1891

Provider Business Practice Location Address
First Line	:	2500 ROCKY MOUNTAIN AVE
Second Line	:	STE 100
City	:	LOVELAND
State	:	CO
Zip	:	80538-9004
Country	:	US
Telephone Number	:	970-624-1800
Fax Number	:	970-624-1891

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	12/07/2022

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Directions to “ DR. MARK D GUADAGNOLI M.D.” Practice Location

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