Provider Demographics
NPI:1780635300
Name:FEDOR, LUBICA (MD)
Entity Type:Individual
Prefix:
First Name:LUBICA
Middle Name:
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 1:1277 DRIVERS CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-9615
Mailing Address - Country:US
Mailing Address - Phone:252-443-5451
Mailing Address - Fax:252-442-4312
Practice Address - Street 1:112 N CIRCLE DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2430
Practice Address - Country:US
Practice Address - Phone:252-443-5451
Practice Address - Fax:252-442-4312
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89131J4Medicaid
NCF06802Medicare UPIN
NC2164663 DMedicare ID - Type Unspecified
NC89131J4Medicaid