Provider Demographics
NPI:1790987980
Name:FEDELEM, LORNA JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:LORNA
Middle Name:JANE
Last Name:FEDELEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9150 GALLERIA CT STE 200
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-4379
Mailing Address - Country:US
Mailing Address - Phone:239-580-6390
Mailing Address - Fax:239-580-6389
Practice Address - Street 1:9150 GALLERIA CT STE 200
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-4379
Practice Address - Country:US
Practice Address - Phone:239-580-6390
Practice Address - Fax:239-580-6389
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100142207Q00000X, 208M00000X
GA060475208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2811341-00Medicaid
FLAJ729ZMedicare Oscar/Certification