Basic Information
| Provider Information | |||||||||
| NPI: | 1952397572 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FEDER | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75B JOHN ROBERTS RD UNIT 8B | ||||||||
| Address2: | |||||||||
| City: | SOUTH PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041063201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077754151 | ||||||||
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| Practice Location | |||||||||
| Address1: | 80 RIVER RD | ||||||||
| Address2: | |||||||||
| City: | NEWCASTLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045533838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075633366 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | DO1583 | ME | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 1583 | ME | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 271620099 | 05 | ME | MEDICAID |