Provider Demographics
NPI:1720241169
Name:INSTITUTE OF PULMONARY DISEASES CSP
Entity type:Organization
Organization Name:INSTITUTE OF PULMONARY DISEASES CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINGO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARDON FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-844-0705
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0518
Mailing Address - Country:US
Mailing Address - Phone:787-844-0705
Mailing Address - Fax:787-844-0706
Practice Address - Street 1:917 AVE
Practice Address - Street 2:TITO CASTRO HOSPITAL SAN LUCAS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4717
Practice Address - Country:US
Practice Address - Phone:787-844-0705
Practice Address - Fax:787-844-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty