ANTHONY RICHARD DECLUSIN MD NPI 1669977997

NPI Information

NPI: 1669977997
Provider Name: ANTHONY RICHARD DECLUSIN, MD
Classification: Psychiatry & Neurology - 2084N0400X
Entity Type: Individual

Specialization: Neurology

PECOS Registration: Yes

Address:
1925 MOUNTAIN VIEW AVE
LONGMONT, CO
ZIP 80501
Phone: (720) 718-8070
Get Directions

Anthony Richard Declusin, MD is a neurology psychiatry neurology in Longmont, CO with 6 years of experience. The provider is a Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. Anthony Richard Declusin, MD NPI is 1669977997. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: MEDICAL COLLEGE OF WISCONSIN
Graduation Year:2018

The provider's business location address is:

1925 MOUNTAIN VIEW AVE
LONGMONT, CO
ZIP 80501-128
Phone: (720) 718-8070
Fax: (720) 494-3107

The NPI 1669977997 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/28/2018 and was last updated on 7/6/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208D00000X	General Practice		DR.0066615	COLORADO	No
2	2084N0400X	Psychiatry & Neurology	Neurology	DR.0066615	COLORADO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	9000163141	MEDICAID	COLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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