Provider Demographics
NPI:1427097310
Name:ASCARELLI, E. DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:E.
Middle Name:DAVID
Last Name:ASCARELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1633 MEDICAL CENTER PT
Mailing Address - Street 2:SUITE 183
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-8732
Mailing Address - Country:US
Mailing Address - Phone:719-635-7172
Mailing Address - Fax:719-444-3771
Practice Address - Street 1:1633 MEDICAL CENTER PT
Practice Address - Street 2:SUITE 183
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8732
Practice Address - Country:US
Practice Address - Phone:719-635-7172
Practice Address - Fax:719-444-3771
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37229207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA49144Medicare UPIN