Healthcare Provider Details

I. General information

NPI: 1508091281
Provider Name (Legal Business Name): JONATHAN CARL FELLERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2009
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CITY CTR STE 8130
PORTLAND ME
04101-6420
US

IV. Provider business mailing address

1 CITY CTR STE 8130
PORTLAND ME
04101-6420
US

V. Phone/Fax

Practice location:
  • Phone: 207-221-0635
  • Fax: 207-221-0634
Mailing address:
  • Phone: 207-221-0635
  • Fax: 207-221-0634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License NumberMD20613
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberMD20613
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD20613
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMD20613
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: