Provider Demographics
NPI:1588897516
Name:FEDER, LINDA R
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:R
Last Name:FEDER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:G
Other - Last Name:RIPPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LDN
Mailing Address - Street 1:623 WESTVIEW ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-3531
Mailing Address - Country:US
Mailing Address - Phone:215-266-3789
Mailing Address - Fax:
Practice Address - Street 1:760 CARPENTER LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-3406
Practice Address - Country:US
Practice Address - Phone:215-848-6880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003053133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered