Provider Demographics
NPI:1144214115
Name:TIRADO MENENDEZ, PEDRO A (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:A
Last Name:TIRADO MENENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1299
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1299
Mailing Address - Country:US
Mailing Address - Phone:787-637-7113
Mailing Address - Fax:787-704-1431
Practice Address - Street 1:CONSOLIDATED MALL
Practice Address - Street 2:SUITE C-27-B
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-637-7113
Practice Address - Fax:787-704-1431
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10406207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84212Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PRF94502Medicare UPIN