Provider Demographics
NPI:1508132119
Name:COLON-RIVERA, HECTOR (MBA, MD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:COLON-RIVERA
Suffix:
Gender:M
Credentials:MBA, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 RISING SUN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-2719
Mailing Address - Country:US
Mailing Address - Phone:267-296-7220
Mailing Address - Fax:
Practice Address - Street 1:4301 RISING SUN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-2719
Practice Address - Country:US
Practice Address - Phone:267-296-7220
Practice Address - Fax:203-781-4624
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4604732084P0802X
CT0547752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008066315OtherCOLON RIVERA MEDICAID
CT008022626Medicaid
CT500000315Medicaid
CT008056168Medicaid
CT004082286Medicaid
PA103409158Medicaid