Provider Demographics
NPI:1699882654
Name:HATANGADI, SHYAMSUNDER B (MD)
Entity type:Individual
Prefix:DR
First Name:SHYAMSUNDER
Middle Name:B
Last Name:HATANGADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2045 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5437
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45828207V00000X
NJMA63268207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ160058939OtherRAILROAD MEDICARE
CO018450OtherKAISER COMMERCIAL NUMBER
CO28625340Medicaid
NJ7959800Medicaid
NJ160058939OtherRAILROAD MEDICARE
CO28625340Medicaid
COG95301Medicare UPIN
NJ028003B3LMedicare ID - Type Unspecified