MEDICARE: DR. NICOLA D. DEMACOPOULOS MD

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	207R00000X	Internal Medicine Physician	49240	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00944697	OTHER	CO	MEDICARE RAILROAD CARRIER PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1205813839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLA D. DEMACOPOULOS MD

Provider Business Mailing Address
First Line	:	4674 SNOW MESA DR
Second Line	:	SUITE 100
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-8615
Country	:	US
Telephone Number	:	970-482-3712
Fax Number	:	970-266-4190

Provider Business Practice Location Address
First Line	:	4674 SNOW MESA DR
Second Line	:	SUITE 100
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-8615
Country	:	US
Telephone Number	:	970-482-3712
Fax Number	:	970-482-4057

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	01/19/2015

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