MEDICARE: MARTHA DAMBROSIO MD PC

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	207RR0500X	Rheumatology Physician	32478	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	:	1700071388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTHA DAMBROSIO MD PC

Provider Business Mailing Address
First Line	:	8295 OLD EXCHANGE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4811
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8295 OLD EXCHANGE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4811
Country	:	US
Telephone Number	:	719-535-8075
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARTHA L DAMBROSIO
Credential	:	MD
Telephone Number	:	719-535-8075

Provider Enumeration Date	:	09/07/2007
Last Update Date	:	01/24/2014

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