Basic Information
| Provider Information | |||||||||
| NPI: | 1902871494 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAPPAPORT | ||||||||
| FirstName: | AVIDAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 W. HAMPDEN AVE. SUITE 600 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801102336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037615646 | ||||||||
| FaxNumber: | 3037619280 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 W. HAMPDEN AVE. SUITE 600 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801102336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037615646 | ||||||||
| FaxNumber: | 3037619280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2006 | ||||||||
| LastUpdateDate: | 02/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 44521 | CO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 91702577 | 05 | CO | MEDICAID |