Provider Demographics
NPI:1104817519
Name:WASHYCHYN, ERIC M (PA)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:WASHYCHYN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8101 E LOWRY BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7196
Mailing Address - Country:US
Mailing Address - Phone:303-214-4500
Mailing Address - Fax:303-214-4571
Practice Address - Street 1:8101 E LOWRY BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7196
Practice Address - Country:US
Practice Address - Phone:303-214-4500
Practice Address - Fax:303-214-4571
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO1335363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPAQ00OtherBLUE CROSS
IDP00172265OtherRAILROAD MEDICARE
ID000010148868OtherBLUE SHIELD
ID000010148866OtherBLUE SHIELD
IDPAQP7OtherBLUE CROSS
P22392Medicare UPIN
ID000010148868OtherBLUE SHIELD