Provider Demographics
NPI:1952397572
Name:FEDER, STEVEN E (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:E
Last Name:FEDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75B JOHN ROBERTS RD UNIT 8B
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3201
Mailing Address - Country:US
Mailing Address - Phone:207-775-4151
Mailing Address - Fax:
Practice Address - Street 1:80 RIVER RD
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:ME
Practice Address - Zip Code:04553-3838
Practice Address - Country:US
Practice Address - Phone:207-563-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO1583208000000X
ME1583208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME271620099Medicaid
ME271620099Medicaid
MEME1727Medicare PIN