Basic Information
| Provider Information | |||||||||
| NPI: | 1962425223 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FEDDER | ||||||||
| FirstName: | IRA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7505 OSLER DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212047736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103378888 | ||||||||
| FaxNumber: | 4108234833 | ||||||||
| Practice Location | |||||||||
| Address1: | 7505 OSLER DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212047736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103378888 | ||||||||
| FaxNumber: | 4108234833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 11/13/2013 | ||||||||
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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 | 207XS0117X | D0037294 | MD | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 330511200 | 05 | MD | MEDICAID |