Provider Demographics
NPI:1093984791
Name:MARC F. FEDDER, MD, PA
Entity Type:Organization
Organization Name:MARC F. FEDDER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:FREDRIC
Authorized Official - Last Name:FEDDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP
Authorized Official - Phone:336-249-4296
Mailing Address - Street 1:PO BOX 557
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27293-0557
Mailing Address - Country:US
Mailing Address - Phone:336-249-4296
Mailing Address - Fax:336-249-1893
Practice Address - Street 1:206 W CENTER ST STE B
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-3056
Practice Address - Country:US
Practice Address - Phone:336-249-4296
Practice Address - Fax:336-249-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26817207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
110006374OtherRAILROAD MEDICARE
2310OtherPARTNERS
31450OtherBLUE CROSS
NC8931450Medicaid
NC8931450Medicaid