Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 38MC00344400 | NJ |
NPI | 1508853854 |
---|---|
Provider Name | Richard Fellows |
First Address | North Cape May, NJ 08204-3500 |
Second Address | North Cape May, NJ 08204-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 13/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U19938 | (02) |