Provider Demographics
NPI:1033107172
Name:FELICIANO, MARCO A (MD)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:A
Last Name:FELICIANO
Suffix:
Gender:M
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 4985
Mailing Address - Street 2:PMB 124
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-4985
Mailing Address - Country:US
Mailing Address - Phone:787-745-1575
Mailing Address - Fax:
Practice Address - Street 1:A1 MUNOZ RIVERA AVE
Practice Address - Street 2:HIMASURGICENTER, SUITE 403
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-745-1575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10388207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF76583Medicare UPIN