Provider Demographics
NPI:1952005308
Name:FELLER, MIA CAROL (BS, MS)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:CAROL
Last Name:FELLER
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 WISCONSIN AVE., NW
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS, 4TH FLOOR
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016
Mailing Address - Country:US
Mailing Address - Phone:202-243-3400
Mailing Address - Fax:202-243-3234
Practice Address - Street 1:4200 WISCONSIN AVE., NW
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS, 4TH FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016
Practice Address - Country:US
Practice Address - Phone:202-243-3400
Practice Address - Fax:202-243-3234
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program