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

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