Provider Demographics
NPI:1871578864
Name:MARCIAL, MANUEL A (MD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:A
Last Name:MARCIAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1760 CALLE LOIZA
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1801
Mailing Address - Country:US
Mailing Address - Phone:787-726-5454
Mailing Address - Fax:787-727-0330
Practice Address - Street 1:1760 CALLE LOIZA
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1801
Practice Address - Country:US
Practice Address - Phone:787-726-5454
Practice Address - Fax:787-727-0330
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2013-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR7716207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC84356Medicare UPIN