Healthcare Provider Details

I. General information

NPI: 1710965009
Provider Name (Legal Business Name): MARK FEDOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARK FEDOR M.D.

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 01/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST SUITE #3740 DEPARTMENT OF NEUROLOGICAL SURGERY
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST SUITE #3740 DEPARTMENT OF NEUROLOGICAL SURGERY
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3071
  • Fax: 916-452-2580
Mailing address:
  • Phone: 916-734-3071
  • Fax: 916-452-2580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA87864
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: