Provider Demographics
NPI:1316280282
Name:FELLNER, DIETER (DPM)
Entity type:Individual
Prefix:DR
First Name:DIETER
Middle Name:
Last Name:FELLNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03581-1502
Mailing Address - Country:US
Mailing Address - Phone:603-466-2741
Mailing Address - Fax:
Practice Address - Street 1:2 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:NH
Practice Address - Zip Code:03581-1502
Practice Address - Country:US
Practice Address - Phone:603-466-2741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006747213ES0131X
NH0385213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery