Provider Demographics
NPI:1730110388
Name:FEDOR, MARY E (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:FEDOR
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 1:2150 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1856
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2150 CENTRAL PARK AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1856
Practice Address - Country:US
Practice Address - Phone:914-337-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042259207R00000X
NY232091207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010042259CT01OtherANTHEM BC/BS
CT229741OtherCIGNA
CT2V7745OtherHEALTH NET
CT1169446OtherAETNA - HMO
CT232091OtherCONNECTICARE
CT7702639OtherAETNA - PPO
CTP3635302OtherOXFORD HEALTH PLAN
CT357AZ1OtherEMPIRE BC/BS
I20988Medicare UPIN
CT110009828Medicare ID - Type Unspecified