Provider Demographics
NPI:1609978642
Name:COLON, ROTCEH (MD)
Entity Type:Individual
Prefix:DR
First Name:ROTCEH
Middle Name:
Last Name:COLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROTCEH
Other - Middle Name:
Other - Last Name:COLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:749 ENRIQUE LAGUERRE
Mailing Address - Street 2:EST DEL GOLF CLUB
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-0546
Mailing Address - Country:US
Mailing Address - Phone:787-360-3607
Mailing Address - Fax:787-259-2696
Practice Address - Street 1:AVE LAS AMERICAS # 2132
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-259-2696
Practice Address - Fax:787-259-2696
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12146208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G46594Medicare UPIN
8899TMedicare ID - Type Unspecified