Provider Demographics
NPI:1346259363
Name:FIEDLER, JOEL M (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:M
Last Name:FIEDLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9234
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:1012 LAUREL OAK RD
Practice Address - Street 2:CHOP CARE NETWORK AT VOORHEES SPECIALTY CARE
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3505
Practice Address - Country:US
Practice Address - Phone:856-435-0086
Practice Address - Fax:856-435-0091
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD031017E208000000X, 2080P0201X
NJ25MA04602400208000000X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001614710Medicaid
NJ0477702Medicaid
PA500528Medicare ID - Type Unspecified
D91736Medicare UPIN
PA001614710Medicaid