Provider Demographics
NPI:1659323970
Name:FELLER, MATTHEW FREDERICK (MD PA)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:FREDERICK
Last Name:FELLER
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:BOWMAN
Mailing Address - State:ND
Mailing Address - Zip Code:58623-4483
Mailing Address - Country:US
Mailing Address - Phone:701-523-5555
Mailing Address - Fax:701-523-7107
Practice Address - Street 1:802 2ND ST NW
Practice Address - Street 2:
Practice Address - City:BOWMAN
Practice Address - State:ND
Practice Address - Zip Code:58623-4483
Practice Address - Country:US
Practice Address - Phone:701-523-5555
Practice Address - Fax:701-523-7107
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04251900207R00000X
NJMA042519207R00000X
NY1497351207R00000X
ND13510207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1462613Medicaid
NJ3150402Medicaid
NY0695AZ10Medicare PIN