Physician Compare National (NPI:1134151194)

HEALTHCARE PROVIDER: TAD FENNAR DPM

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1134151194
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5698890648
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100914000527
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FENNAR
	Individual professional last name
Provider First Name	TAD
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NEW YORK COLLEGE OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	1996
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1300 W 6TH ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 2
	Group Practice or individual's line 2 address
City	SAN PEDRO
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	907323531
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3108310728
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y