Provider Demographics
NPI:1790780336
Name:FEDER, SETH (MD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:FEDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-5138
Mailing Address - Country:US
Mailing Address - Phone:401-942-9005
Mailing Address - Fax:401-464-8664
Practice Address - Street 1:989 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-5138
Practice Address - Country:US
Practice Address - Phone:401-942-9005
Practice Address - Fax:401-464-8664
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI5805207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9001000Medicaid
RI1000OtherBLUE CROSS
RI000765OtherBLUE CHIP
RI000765OtherBLUE CHIP
RI1000OtherBLUE CROSS