Basic Information
| Provider Information | |||||||||
| NPI: | 1710965009 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FEDOR | ||||||||
| FirstName: | MARK | ||||||||
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| OtherLastName: | FEDOR | ||||||||
| OtherFirstName: | MARK | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4860 Y ST | ||||||||
| Address2: | SUITE #3740 DEPARTMENT OF NEUROLOGICAL SURGERY | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167343071 | ||||||||
| FaxNumber: | 9164522580 | ||||||||
| Practice Location | |||||||||
| Address1: | 4860 Y ST | ||||||||
| Address2: | SUITE #3740 DEPARTMENT OF NEUROLOGICAL SURGERY | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167343071 | ||||||||
| FaxNumber: | 9164522580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 01/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | A87864 | CA | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.