Healthcare Provider Details

I. General information

NPI: 1770864092
Provider Name (Legal Business Name): KURT ANDREW FEDORA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 POMEROY TER
NORTHAMPTON MA
01060-3378
US

IV. Provider business mailing address

78 POMEROY TER
NORTHAMPTON MA
01060-3378
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-1310
  • Fax: 413-586-1496
Mailing address:
  • Phone: 413-584-1310
  • Fax: 413-586-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: