Healthcare Provider Details

I. General information

NPI: 1457450553
Provider Name (Legal Business Name): EDWARD C FEDERMAN M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6699 ALVARADO RD STE 2309
SAN DIEGO CA
92120-5241
US

IV. Provider business mailing address

PO BOX 1009
SPRING VALLEY CA
91979-1009
US

V. Phone/Fax

Practice location:
  • Phone: 619-286-8803
  • Fax: 619-286-2344
Mailing address:
  • Phone: 619-508-0908
  • Fax: 619-693-3242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD CHARLES FEDERMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 619-286-8803