Provider Demographics
NPI:1275600215
Name:MEDINA COLON, MAGALY (MD)
Entity Type:Individual
Prefix:
First Name:MAGALY
Middle Name:
Last Name:MEDINA COLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 PONCE BY PASS
Mailing Address - Street 2:EDIFICIO PARRA SUITE 404
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731
Mailing Address - Country:US
Mailing Address - Phone:787-290-0135
Mailing Address - Fax:787-284-5398
Practice Address - Street 1:2225 PONCE BY PASS
Practice Address - Street 2:EDIFICIO PARRA SUITE 404
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-290-0135
Practice Address - Fax:787-284-5398
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15859207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2-3319Medicare ID - Type Unspecified
I-20463Medicare UPIN