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General NPI Number Information
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NPI Number | 1083702427
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Entity Type | Individual
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Provider Name | MANUEL ANGEL COLON-DEJESUS M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 1057 MERIDIAN DRIVE
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City | SNEADS FERRY
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State | NC
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Zip | 28460
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Country | US
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Telephone | 678-328-9539
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Fax |
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Provider Business Mailing Address
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Address Line | 1057 MERIDIAN DRIVE
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City | SNEADS FERRY
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State | NC
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Zip | 28460
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Country | US
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Telephone | 678-328-9539
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 9812
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 46838
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License Number State | GA
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