Individual
JEFFREY FEDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
593 EDDY ST, CLAVERICK 2, PROVIDENCE, RI 02903-4923
(401) 519-1604
(401) 272-0538
Mailing address
PO BOX 9484, PROVIDENCE, RI 02940-9484
(401) 854-2500
(401) 854-2519
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD12715
RI
207P00000X
Emergency Medicine Physician
MD429607
PA
207PS0010X
Sports Medicine (Emergency Medicine) Physician
12715
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007060506
RI MEDICARE
RI
01
—
04/15/2009
UNITED HEALTHCARE
RI
01
—
09-30-2008
BCBS
RI
01
—
10-30-2008
NHPRI
RI
05
—
110081793A
—
RI
01
—
12/29/2008
TUFTS HEALTH PLAN
MA
01
—
939025129
UEMF GROUP RI MEDICARE
RI
05
—
JF72799
—
RI
01
—
P00671207
RAILROAD MEDICARE
RI
Enumeration date
06/08/2007
Last updated
08/22/2013
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