1760655393 NPI number — MS. MELINDA STUPAR FEDORIS MSED

Table of content: MS. MELINDA STUPAR FEDORIS MSED (NPI 1760655393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760655393 NPI number — MS. MELINDA STUPAR FEDORIS MSED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEDORIS
Provider First Name:
MELINDA
Provider Middle Name:
STUPAR
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STUPAR
Provider Other First Name:
MELINDA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSED
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760655393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1803 WEST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMESTEAD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15120-2572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-368-3535
Provider Business Mailing Address Fax Number:
412-326-0210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1803 WEST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMESTEAD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15120-2572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-368-3535
Provider Business Practice Location Address Fax Number:
412-326-0210
Provider Enumeration Date:
04/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  PC004156 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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