Provider Demographics
NPI: | 1932369998 |
---|---|
Name: | TONEY, AMANDA GREENE (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | AMANDA |
Middle Name: | GREENE |
Last Name: | TONEY |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | DR |
Other - First Name: | AMANDA |
Other - Middle Name: | ELIZABETH |
Other - Last Name: | GREENE |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | 777 BANNOCK ST |
Mailing Address - Street 2: | |
Mailing Address - City: | DENVER |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80204-4597 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 303-602-2273 |
Mailing Address - Fax: | 303-602-3310 |
Practice Address - Street 1: | 777 BANNOCK ST |
Practice Address - Street 2: | |
Practice Address - City: | DENVER |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80204-4597 |
Practice Address - Country: | US |
Practice Address - Phone: | 303-602-2273 |
Practice Address - Fax: | 303-602-3310 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2008-06-13 |
Last Update Date: | 2025-06-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | DR.0047587 | 208000000X, 207PP0204X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207PP0204X | Allopathic & Osteopathic Physicians | Emergency Medicine | Pediatric Emergency Medicine |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CO | 86650874 | Medicaid | |
CO | CO307009 | Medicare PIN |