MEDICARE: HECTOR COLON-RIVERA MBA, MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0802X	Addiction Psychiatry Physician	MD460473	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508132119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HECTOR COLON-RIVERA MBA, MD

Provider Business Mailing Address
First Line	:	4301 RISING SUN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-2719
Country	:	US
Telephone Number	:	267-296-7220
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 RISING SUN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-2719
Country	:	US
Telephone Number	:	267-296-7220
Fax Number	:	203-781-4624

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2012
Last Update Date	:	01/26/2023

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