Basic Information
| Provider Information | |||||||||
| NPI: | 1073591715 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORERO | ||||||||
| FirstName: | MANUEL | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2315 MYRTLE ST STE 190 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165024604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144537767 | ||||||||
| FaxNumber: | 8144546667 | ||||||||
| Practice Location | |||||||||
| Address1: | 287 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | MEADVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163352521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143372355 | ||||||||
| FaxNumber: | 8143373751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 09/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD050282L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0014225600007 | 05 | PA | MEDICAID |