Provider Demographics
NPI:1083702427
Name:COLON-DEJESUS, MANUEL ANGEL (MD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:ANGEL
Last Name:COLON-DEJESUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MANUEL
Other - Middle Name:ANGEL
Other - Last Name:COLON-DEJESUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1057 MERIDIAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460
Mailing Address - Country:US
Mailing Address - Phone:678-328-9539
Mailing Address - Fax:
Practice Address - Street 1:1057 MERIDIAN DRIVE
Practice Address - Street 2:
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460
Practice Address - Country:US
Practice Address - Phone:678-328-9539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9812207LP2900X, 207L00000X
GA46838207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13170Medicaid
MI700G560080OtherBCBS GROUP, TRH
NE10025792100Medicaid
MI0507500032OtherBCBS TRH
ND24757Medicare UPIN
H46220Medicare UPIN
MI0507500032OtherBCBS TRH
NDN718540Medicare PIN
MIG56008088Medicare PIN
NE10025792100Medicaid
NENA1440017Medicare PIN