Provider Demographics
NPI:1477633907
Name:FEDER, LEWIS IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:IRA
Last Name:FEDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LEWIS
Other - Middle Name:IRA
Other - Last Name:FEDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:65 FREMONT ST
Mailing Address - Street 2:POST OFFICE BOX 390
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1271
Mailing Address - Country:US
Mailing Address - Phone:508-485-4012
Mailing Address - Fax:508-485-1419
Practice Address - Street 1:65 FREMONT ST
Practice Address - Street 2:SUITE NUMBER 5
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1271
Practice Address - Country:US
Practice Address - Phone:508-485-4012
Practice Address - Fax:508-485-1419
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34371207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2021285Medicaid
MAM11394Medicare ID - Type Unspecified
MA2021285Medicaid