Provider Demographics
NPI:1780801662
Name:MRP MEDICAL SERVICES CSP
Entity type:Organization
Organization Name:MRP MEDICAL SERVICES CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:ROMAN PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-817-8681
Mailing Address - Street 1:PMB 022
Mailing Address - Street 2:BOX 8901
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659
Mailing Address - Country:US
Mailing Address - Phone:787-817-8681
Mailing Address - Fax:787-817-8681
Practice Address - Street 1:CALLE ANA D LENS #50
Practice Address - Street 2:MRP MEDICAL SERVICES CSP
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-817-8681
Practice Address - Fax:787-817-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88532Medicare PIN
G06805Medicare UPIN