Provider Demographics
NPI:1417084187
Name:FELLER, EDWARD ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ROY
Last Name:FELLER
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 1:65 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-1331
Mailing Address - Country:US
Mailing Address - Phone:401-272-7607
Mailing Address - Fax:
Practice Address - Street 1:65 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-1331
Practice Address - Country:US
Practice Address - Phone:401-272-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI5307207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine