Healthcare Provider Details

I. General information

NPI: 1023040326
Provider Name (Legal Business Name): MICHAEL T COLON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S MANNING BLVD SUITE 203
ALBANY NY
12208-1742
US

IV. Provider business mailing address

319 S MANNING BLVD SUITE 203
ALBANY NY
12208-1742
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-3292
  • Fax: 518-453-6286
Mailing address:
  • Phone: 518-489-3292
  • Fax: 518-453-6286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number044231
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number2567541
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: