MEDICARE: DR. ANDREW S. TEDESCO M.D.

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	207NS0135X	Procedural Dermatology Physician	11617	AZ

General Provider Information

NPI Number	:	1235128851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW S. TEDESCO M.D.

Provider Business Mailing Address
First Line	:	6648 E CARONDELET DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-2119
Country	:	US
Telephone Number	:	520-886-8151
Fax Number	:	520-885-1404

Provider Business Practice Location Address
First Line	:	6648 E CARONDELET DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-2119
Country	:	US
Telephone Number	:	520-886-8151
Fax Number	:	520-885-1404

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	04/20/2011

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