Provider Demographics
NPI:1659323970
Name:FELLER, MATTHEW FREDERICK (MD PA)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:FREDERICK
Last Name:FELLER
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:300 GORGE RD APT 48
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-2768
Mailing Address - Country:US
Mailing Address - Phone:201-724-3362
Mailing Address - Fax:201-648-2513
Practice Address - Street 1:99 E STATE ST
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-1203
Practice Address - Country:US
Practice Address - Phone:518-773-5780
Practice Address - Fax:201-648-2513
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK42675207P00000X
NJ25MA04251900207R00000X
NJMA042519207R00000X
NY1497351207R00000X
ND13510207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1462613Medicaid
NJ3150402Medicaid
NY0695AZ10Medicare PIN