Provider Demographics
NPI:1174742944
Name:BARATTA, MARK (PA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BARATTA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3455 LUTHERAN PKWY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6028
Mailing Address - Country:US
Mailing Address - Phone:303-403-7300
Mailing Address - Fax:303-403-7310
Practice Address - Street 1:3455 LUTHERAN PKWY
Practice Address - Street 2:SUITE 280
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6028
Practice Address - Country:US
Practice Address - Phone:303-403-7300
Practice Address - Fax:303-403-7310
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2019-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
0064591363A00000X
FLPA9107209363A00000X
COPA-3186363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25258231Medicaid
CO25258231Medicaid
5665L1Medicare PIN