Healthcare Provider Details

I. General information

NPI: 1447246178
Provider Name (Legal Business Name): DOROTHY S FEDERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MAIN ST
SARANAC LAKE NY
12983-1705
US

IV. Provider business mailing address

118 MAIN ST
SARANAC LAKE NY
12983-1705
US

V. Phone/Fax

Practice location:
  • Phone: 518-891-4000
  • Fax: 518-891-2598
Mailing address:
  • Phone: 518-891-4000
  • Fax: 518-891-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number123529
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: