Provider Demographics
NPI:1447224746
Name:MARCANO, MANUEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:E
Last Name:MARCANO
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 4035
Mailing Address - Street 2:SUITE 457
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-4035
Mailing Address - Country:US
Mailing Address - Phone:787-878-7274
Mailing Address - Fax:787-880-7733
Practice Address - Street 1:115 CALLE ARIOSTO CRUZ
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-878-7274
Practice Address - Fax:787-880-7733
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9885208D00000X
PRTC AMB 2953416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41574Medicare UPIN
PR28864Medicare ID - Type Unspecified