Healthcare Provider Details

I. General information

NPI: 1235225624
Provider Name (Legal Business Name): MATTHEW C FEDOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 HAWTHORNE AVE SE STE 110
SALEM OR
97301
US

IV. Provider business mailing address

PO BOX 886
SALEM OR
97308-0886
US

V. Phone/Fax

Practice location:
  • Phone: 503-814-4440
  • Fax: 503-814-4444
Mailing address:
  • Phone: 503-814-4440
  • Fax: 503-814-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD27542
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: