MEDICARE: PULMONARY MEDICINE & INFECTIOUS DISEASE MEDICAL GROUP

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	207RP1001X	Pulmonary Disease Physician		CA
2	207RI0200X	Infectious Disease Physician		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619004421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULMONARY MEDICINE & INFECTIOUS DISEASE MEDICAL GROUP

Provider Business Mailing Address
First Line	:	6699 ALVARADO RD
Second Line	:	SUITE 2308
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5244
Country	:	US
Telephone Number	:	619-462-9010
Fax Number	:	619-287-8165

Provider Business Practice Location Address
First Line	:	6699 ALVARADO RD
Second Line	:	SUITE 2308
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5244
Country	:	US
Telephone Number	:	619-462-9010
Fax Number	:	619-287-8165

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. EDWARD C FEDERMAN
Credential	:	M.D.
Telephone Number	:	619-462-9010

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/24/2015

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1598761413 — DR. DOUGLAS DEAN DENGERINK D.O.
Practice Location Address:

6699 ALVARADO RD , SUITE 2100
SAN DIEGO, CA
92120-5244

Practice Phone: 619-229-3909
Practice Fax: 619-229-3902

1356449425 — DR. TREVOR HOWARD HENDERSON MD
Practice Location Address:

6699 ALVARADO RD , SUITE 2200
SAN DIEGO, CA
92120-5244

Practice Phone: 619-265-3400
Practice Fax: 619-265-3407

1952496291 — OLEG M GAVRILYUK M.D.
Practice Location Address:

6699 ALVARADO RD , STE. 2302
SAN DIEGO, CA
92120-5244

Practice Phone: 619-578-2518
Practice Fax: 619-501-6498

1679764179 — DR. MELISSA KAGNOFF M.D.
Practice Location Address:

6699 ALVARADO RD , SUITE 2301
SAN DIEGO, CA
92120-5244

Practice Phone: 619-582-2595
Practice Fax: 619-229-8006

1568624336 — DR. CHITRA SAFAYA MD
Practice Location Address:

6699 ALVARADO RD , SUITE 2308
SAN DIEGO, CA
92120-5244

Practice Phone: 619-462-9010
Practice Fax: 619-287-8165

Directions to “PULMONARY MEDICINE & INFECTIOUS DISEASE MEDICAL GROUP ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.