Individual
LAURENCE A BERARDUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
3670 PARKER BLVD, SUITE 101, PUEBLO, CO 81008-2285
(719) 564-1544
(719) 924-1593
Mailing address
3670 PARKER BLVD, SUITE 101, PUEBLO, CO 81008-2285
(719) 564-1544
(719) 924-1593
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
102133
MO
207RC0000X
Cardiovascular Disease Physician
Primary
51214
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39223361
—
CO
01
—
P01102505
RAILROAD MEDICARE
CO
Enumeration date
06/24/2005
Last updated
07/22/2013
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