Physician Compare National (NPI:1366574725)

HEALTHCARE PROVIDER: CARLOS MANUEL TEJEDA M.D.

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

Individual Professional Information
NPI	1366574725
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0648162214
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20151207001194
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TEJEDA
	Individual professional last name
Provider First Name	CARLOS
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF PUERTO RICO SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1994
	Individual professional's medical school graduation year
Primary Specialty	HEMATOLOGY/ONCOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	410 AVE GENERAL VALERO
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 205
	Group Practice or individual's line 2 address
City	FAJARDO
	Group Practice or individual's city
State	PR
	Group Practice or individual's state
Zip Code	007383988
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	400007
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	RYDER MEMORIAL HOSPITAL INC
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y