MEDICARE: MARKAN MEDICINE CSP

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	261Q00000X	Clinic/Center	5	PR

General Provider Information

NPI Number	:	1689996647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARKAN MEDICINE CSP

Provider Business Mailing Address
First Line	:	PO BOX 4035
Second Line	:	SUITE 456
City	:	ARECIBO
State	:	PR
Zip	:	00613-4035
Country	:	US
Telephone Number	:	787-878-3151
Fax Number	:	787-880-7733

Provider Business Practice Location Address
First Line	:	115 CALLE ARIOSTO CRUZ
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-4745
Country	:	US
Telephone Number	:	787-878-3152
Fax Number	:	787-880-7733

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MANUEL E. MARCANO-RIVERA
Credential	:	M.D.
Telephone Number	:	787-878-3151

Provider Enumeration Date	:	02/18/2010
Last Update Date	:	02/18/2010

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