Provider Demographics
NPI:1508867979
Name:FEDER, ARLENE S (MD)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:S
Last Name:FEDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 COLLIERS WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5058
Mailing Address - Country:US
Mailing Address - Phone:304-797-6404
Mailing Address - Fax:
Practice Address - Street 1:651 COLLIERS WAY STE 412
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5055
Practice Address - Country:US
Practice Address - Phone:304-723-3400
Practice Address - Fax:304-723-3093
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12829207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
001718165OtherMOUNTAIN STATE BCBS
WV0083551000Medicaid
12829BOtherHEALTH PLAN OF UPPER OH V
OH0479110Medicaid
B42608Medicare UPIN
12829BOtherHEALTH PLAN OF UPPER OH V
WV0083551000Medicaid