Provider Demographics
NPI:1932219896
Name:COLON, MANUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:A
Last Name:COLON
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:BOX MSC 442
Mailing Address - Street 2:P O BOX 4035
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614
Mailing Address - Country:US
Mailing Address - Phone:787-817-3996
Mailing Address - Fax:787-816-9310
Practice Address - Street 1:101 CALLE FCO GONZALO MARIN
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4754
Practice Address - Country:US
Practice Address - Phone:787-817-3996
Practice Address - Fax:787-816-9310
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5388207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
98970Medicare ID - Type Unspecified
G41109Medicare UPIN