Individual
MICHAEL JOHN FEDOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
3100 SCHOOLHOUSE RD, MIDDLETOWN, PA 17057-3548
(717) 948-5180
(717) 948-0488
Mailing address
PO BOX 858, MC A410, HERSHEY, PA 17033-0858
(800) 243-1455
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP009349
PA
363LF0000X
Family Nurse Practitioner
26NJ00086500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1032124840001
—
PA
01
—
110413NZR
MEDICARE PTAN
PA
Enumeration date
10/02/2006
Last updated
07/21/2022
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