Provider Demographics
NPI:1093872996
Name:FEDER, MILTON WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:WILLIAM
Last Name:FEDER
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 1:3827 DANCE MILL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-2117
Mailing Address - Country:US
Mailing Address - Phone:410-221-2430
Mailing Address - Fax:
Practice Address - Street 1:5262 WOODS RD
Practice Address - Street 2:EASTERN SHORE HOSPITAL CENTER
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-3796
Practice Address - Country:US
Practice Address - Phone:410-221-2430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD244992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD77692Medicare UPIN