Healthcare Provider Details

I. General information

NPI: 1386635167
Provider Name (Legal Business Name): EUGENE FELLIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N RICHMOND ST
FLEETWOOD PA
19522-1058
US

IV. Provider business mailing address

805 N RICHMOND ST
FLEETWOOD PA
19522-1058
US

V. Phone/Fax

Practice location:
  • Phone: 610-944-0464
  • Fax: 610-944-9733
Mailing address:
  • Phone: 610-944-0464
  • Fax: 610-944-9733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS0047164L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: