Provider Demographics
NPI:1073591715
Name:FORERO, MANUEL F (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:F
Last Name:FORERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2315 MYRTLE ST STE 190
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-4604
Mailing Address - Country:US
Mailing Address - Phone:814-453-7767
Mailing Address - Fax:814-454-6667
Practice Address - Street 1:287 NORTH ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2521
Practice Address - Country:US
Practice Address - Phone:814-337-2355
Practice Address - Fax:814-337-3751
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD050282L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014225600007Medicaid
PAF60316Medicare UPIN
PA0014225600007Medicaid
PA027462Medicare ID - Type Unspecified