Provider Demographics
NPI:1134386154
Name:BERTELSON, NOELLE (MD)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:BERTELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 S BANNOCK ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2432
Mailing Address - Country:US
Mailing Address - Phone:303-957-1310
Mailing Address - Fax:303-761-4252
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:SUITE 6300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1216
Practice Address - Country:US
Practice Address - Phone:303-839-5669
Practice Address - Fax:303-839-1216
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42213208C00000X
NE27047208C00000X
AZ42213208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51125048Medicaid
AZ455570Medicaid
AZZ138374Medicare PIN
AZ455570Medicaid