Provider Demographics
NPI:1851390272
Name:FEDDER, STEPHEN L (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:FEDDER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:107 GREEN LN
Mailing Address - Street 2:SUITE 655
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-2025
Mailing Address - Country:US
Mailing Address - Phone:610-649-4416
Mailing Address - Fax:610-649-3655
Practice Address - Street 1:107 GREEN LN
Practice Address - Street 2:SUITE 655
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-2025
Practice Address - Country:US
Practice Address - Phone:610-649-4416
Practice Address - Fax:610-649-3655
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2016-03-07
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Provider Licenses
StateLicense IDTaxonomies
PAMD027140E207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B41946Medicare UPIN