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NPI Code Detail

MEDICARE: DR. MARC Y WASSERMAN M.D.

MEDICARE: DR. MARC Y WASSERMAN 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
1174400000XSpecialist036110646IL
22084N0400XNeurology Physician37826AZ
32084N0400XNeurology PhysicianDR.0050778CO

Other Identifiers

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

General Provider Information

NPI Number : 1356340467
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARC Y WASSERMAN M.D.
Provider Business Mailing Address
First Line : 2695 ROCKY MOUNTAIN AVE STE 150
Second Line :
City : LOVELAND
State : CO
Zip : 80538-9071
Country : US
Telephone Number :
Fax Number : 720-274-0064
Provider Business Practice Location Address
First Line : 8155 PINEY RIVER AVE STE 100
Second Line :
City : LITTLETON
State : CO
Zip : 80125-8729
Country : US
Telephone Number : 303-265-3390
Fax Number : 720-274-0064
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2005
Last Update Date : 10/08/2021

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