MEDICARE: ARLENE M FEDORCHAK MD

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	207R00000X	Internal Medicine Physician	35.059885	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891998340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARLENE M FEDORCHAK MD

Provider Business Mailing Address
First Line	:	4825 KNIGHTSBRIDGE BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-4325
Country	:	US
Telephone Number	:	614-451-9612
Fax Number	:	614-451-2009

Provider Business Practice Location Address
First Line	:	4825 KNIGHTSBRIDGE BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-4325
Country	:	US
Telephone Number	:	614-451-9612
Fax Number	:	614-451-2009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	10/29/2019

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