Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 14412 | SC |
Y | 207RC0000X | Internist - Cardiovascular Disease | 20899 | NC |
NPI | 1003827296 |
---|---|
Provider Name | John Fedor |
First Address | Charlotte, NC 28219-9305 |
Second Address | Charlotte, NC 28204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 30/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C83719 | (02) |