Healthcare Provider Details

I. General information

NPI: 1023091410
Provider Name (Legal Business Name): ROBERTO F MARCHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 AVE J T PINERO
SAN JUAN PR
00927-3901
US

IV. Provider business mailing address

271 AVE J T PINERO
SAN JUAN PR
00927-3901
US

V. Phone/Fax

Practice location:
  • Phone: 787-759-9660
  • Fax: 787-759-9660
Mailing address:
  • Phone: 787-759-9660
  • Fax: 787-759-9660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number5726
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: