Individual
DR. CHARLES ROBERT FEDELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1229 PENNSYLVANIA AVENUE, SAYRE, PA 18840
(570) 888-5858
Mailing address
1229 PENNSYLVANIA AVE, SAYRE, PA 18840-1047
(570) 888-9140
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
119115-1
NY
207N00000X
Dermatology Physician
Primary
MD037378L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00365155
—
NY
Enumeration date
02/23/2006
Last updated
07/08/2007
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