Provider Demographics
NPI:1861514275
Name:MASTALERZ, KATARZYNA AGNIESZKA (MD)
Entity type:Individual
Prefix:
First Name:KATARZYNA
Middle Name:AGNIESZKA
Last Name:MASTALERZ
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:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1721 E 19TH AVE
Practice Address - Street 2:SUITE 520
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1243
Practice Address - Country:US
Practice Address - Phone:303-869-2440
Practice Address - Fax:303-869-2544
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48931207R00000X
CODR.0048931208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37301365Medicaid
CO37301365Medicaid
COP01659556Medicare PIN