Provider Demographics
NPI:1033166202
Name:FEDIS, DOROTHY P (MD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:P
Last Name:FEDIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8160
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-8160
Mailing Address - Country:US
Mailing Address - Phone:410-787-4565
Mailing Address - Fax:410-766-7602
Practice Address - Street 1:301 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5803
Practice Address - Country:US
Practice Address - Phone:410-787-4565
Practice Address - Fax:410-766-7602
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD57149207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD808104200Medicaid
MDK727A851Medicare PIN