Basic Information
| Provider Information | |||||||||
| NPI: | 1891777405 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FEHR | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 SUMMER ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016081216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083683150 | ||||||||
| FaxNumber: | 5083683152 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 SUMMER ST | ||||||||
| Address2: | SUITE 230S | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016081216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083683150 | ||||||||
| FaxNumber: | 5083683152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 08/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 78002 | MA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 042472266 | 01 | ONE HEALTH PLAN | OTHER | AA3710 | 01 | HARVARD PILGRIM | OTHER | J14259 | 01 | BLUE SHIELD INDEMNITY | OTHER | J14259 | 01 | BLUE SHIELD HMO BLUE | OTHER | 0500191 | 01 | EVERCARE | OTHER | 1044150 | 01 | CIGNA | OTHER | 464655 | 01 | TUFTS HEALTH PLAN | OTHER | 042472266 | 01 | TRICARE / CHAMPUS | OTHER | 26808 | 01 | HEALTHY START | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | 130018948 | 01 | RAILROAD MEDICARE | OTHER | 4465395 | 01 | AETNA | OTHER | 935011 | 01 | FIRST HEALTH | OTHER | 3115224 | 05 | MA | MEDICAID | 784018 | 01 | MVP HEALTH CARE | OTHER | J14259 | 01 | BLUE CARE ELECT | OTHER | 042472266 | 01 | UNITED HEALTHCARE | OTHER | 991067 | 01 | FALLON COMMUNITY HEALTH | OTHER |