MEDICARE: DR. MARK A DILLINGHAM 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	207RN0300X	Nephrology Physician	23200	CO

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

General Provider Information

NPI Number	:	1437142734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A DILLINGHAM M.D.

Provider Business Mailing Address
First Line	:	130 RAMPART WAY
Second Line	:	STE 300B
City	:	DENVER
State	:	CO
Zip	:	80230-6451
Country	:	US
Telephone Number	:	303-343-4700
Fax Number	:	303-343-4711

Provider Business Practice Location Address
First Line	:	950 E HARVARD AVE
Second Line	:	SUITE 240
City	:	DENVER
State	:	CO
Zip	:	80210-7006
Country	:	US
Telephone Number	:	303-871-0977
Fax Number	:	303-733-2387

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	06/20/2016

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