MEDICARE: THOMAS W. FELL, JR., M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	G26187	CA

General Provider Information

NPI Number	:	1851429393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS W. FELL, JR., M.D.

Provider Business Mailing Address
First Line	:	4940 VAN NUYS BLVD
Second Line	:	SUITE 302
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1700
Country	:	US
Telephone Number	:	818-990-4497
Fax Number	:	818-990-6045

Provider Business Practice Location Address
First Line	:	4940 VAN NUYS BLVD
Second Line	:	SUITE 302
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1700
Country	:	US
Telephone Number	:	818-990-4497
Fax Number	:	818-990-6045

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS W. FELL JR.
Credential	:	M.D.
Telephone Number	:	818-990-4497

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	03/12/2010

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