Basic Information
| Provider Information | |||||||||
| NPI: | 1851493613 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSH | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | STEVENS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MARSH | ||||||||
| OtherFirstName: | EMILY | ||||||||
| OtherMiddleName: | S. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4100 E MISSISSIPPI AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802463051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035529522 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4100 E MISSISSIPPI AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802463051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035529522 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2006 | ||||||||
| LastUpdateDate: | 04/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 36903 | CO | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | DR.0036903 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01369032 | 05 | CO | MEDICAID | 85288721 | 05 | CO | MEDICAID | P00637685 | 01 | CO | RAIL ROAD MEDICARE | OTHER |