Provider Demographics
NPI:1841267200
Name:COLON MARTINEZ, ROLANDO (MD)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:
Last Name:COLON MARTINEZ
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 1:54 AVE BARBOSA
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4328
Mailing Address - Country:US
Mailing Address - Phone:787-817-3975
Mailing Address - Fax:787-817-3974
Practice Address - Street 1:54 AVE BARBOSA
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4328
Practice Address - Country:US
Practice Address - Phone:787-817-3975
Practice Address - Fax:787-817-3974
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12017208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0088988Medicare PIN
PRH55665Medicare UPIN