Provider Demographics
NPI:1154434397
Name:STATLAND, BARBARA D (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:D
Last Name:STATLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:S
Other - Last Name:CLEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:MC 4000
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4507
Mailing Address - Country:US
Mailing Address - Phone:303-602-5011
Mailing Address - Fax:303-602-5056
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:MC 4000
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4507
Practice Address - Country:US
Practice Address - Phone:303-602-5011
Practice Address - Fax:303-602-5056
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05977029Medicaid
CO05977029Medicaid
CO444918Medicare ID - Type Unspecified