Provider Demographics
NPI:1598537722
Name:COLBERG MD LLC
Entity Type:Organization
Organization Name:COLBERG MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:COLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-354-5695
Mailing Address - Street 1:271 CALLE REY GUSTAVO
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3262
Mailing Address - Country:US
Mailing Address - Phone:787-354-5695
Mailing Address - Fax:
Practice Address - Street 1:101 AVE SAN PATRICIO STE 840
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-2680
Practice Address - Country:US
Practice Address - Phone:787-354-5695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty