Individual
GREGORY MALCOLM FEDELE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D. FACS
Contact information
Practice address
25201 CHAGRIN BLVD, SUITE 180, BEACHWOOD, OH 44122-5600
(216) 464-1616
(216) 464-1618
Mailing address
PO BOX 1086, WILLOUGHBY, OH 44096-1086
(216) 645-7242
(440) 975-8278
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
35.070501
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2500289
—
OH
Enumeration date
09/06/2006
Last updated
07/07/2015
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