Provider Demographics
NPI:1710965009
Name:FEDOR, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:FEDOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:FEDOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:SUITE #3740 DEPARTMENT OF NEUROLOGICAL SURGERY
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-3071
Mailing Address - Fax:916-452-2580
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE #3740 DEPARTMENT OF NEUROLOGICAL SURGERY
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-3071
Practice Address - Fax:916-452-2580
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87864207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery