Healthcare Provider Details

I. General information

NPI: 1497955975
Provider Name (Legal Business Name): ELAN COLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 08/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AMERICO MIRANDA AVE SAN JUAN
SAN JUAN PR
00935-0001
US

IV. Provider business mailing address

AMERICO MIRANDA AVE SAN JUAN
SAN JUAN PR
00935-0001
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3535
  • Fax:
Mailing address:
  • Phone: 787-777-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25843
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number26451
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: