Individual
MR. JASON ROBERT FEDAK
Active
Individual
MR. JASON ROBERT FEDAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001470
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
147000
CONNECTICARE
—
01
—
290001470CT01
ANTHEM BCBS
—
01
—
2V4615
HEALTHNET OF THE NORTHEAS
—
01
—
P3613396
OXFORD HEALTH PLANS
—
Enumeration date
10/02/2006
Last updated
03/02/2015
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