Provider Demographics
NPI:1497955975
Name:COLEN, ELAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAN
Middle Name:
Last Name:COLEN
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:AMERICO MIRANDA AVE
Mailing Address - Street 2:SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00935-0001
Mailing Address - Country:US
Mailing Address - Phone:787-777-3535
Mailing Address - Fax:
Practice Address - Street 1:AMERICO MIRANDA AVE
Practice Address - Street 2:SAN JUAN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25843208000000X
PR264512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics