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Organization
BOULDER VALLEY PATHOLOGY P C
Active
Organization
BOULDER VALLEY PATHOLOGY P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN W HANLEY M.D. (PRESIDENT)
(303) 465-0401
Entity
Organization
Contact information
Practice address
4747 ARAPAHOE AVE, BOULDER, CO 80303-1131
(303) 415-7000
Mailing address
42 GARDEN CTR, BROOMFIELD, CO 80020-1730
(303) 465-0401
(303) 438-1351
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04984043
—
CO
01
—
CN8338
MEDICARE RAILROAD
CO
Enumeration date
03/29/2006
Last updated
03/15/2021
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