MEDICARE: RICHARD L VANDENBERGH 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	101YM0800X	Mental Health Counselor	15692	CO

General Provider Information

NPI Number	:	1841503323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD L VANDENBERGH MD PC

Provider Business Mailing Address
First Line	:	1777 S HARRISON ST PH P300
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-3939
Country	:	US
Telephone Number	:	303-758-3188
Fax Number	:	303-758-1145

Provider Business Practice Location Address
First Line	:	1777 S HARRISON ST PH P300
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-3939
Country	:	US
Telephone Number	:	303-758-3188
Fax Number	:	303-758-1145

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. RICHARD L VANDENBERGH
Credential	:	M.D.
Telephone Number	:	303-758-3188

Provider Enumeration Date	:	07/26/2010
Last Update Date	:	07/26/2010

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