Provider Demographics
NPI:1962425223
Name:FEDDER, IRA L (MD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:L
Last Name:FEDDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7505 OSLER DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7736
Mailing Address - Country:US
Mailing Address - Phone:410-337-8888
Mailing Address - Fax:410-823-4833
Practice Address - Street 1:7505 OSLER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7736
Practice Address - Country:US
Practice Address - Phone:410-337-8888
Practice Address - Fax:410-823-4833
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0037294207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD330511200Medicaid
MDS783A058Medicare ID - Type Unspecified
MDE94079Medicare UPIN