Healthcare Provider Details

I. General information

NPI: 1508867979
Provider Name (Legal Business Name): ARLENE S FEDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 COLLIERS WAY STE 412
WEIRTON WV
26062-5055
US

IV. Provider business mailing address

651 COLLIERS WAY STE 300
WEIRTON WV
26062-5058
US

V. Phone/Fax

Practice location:
  • Phone: 304-723-3400
  • Fax: 304-723-3093
Mailing address:
  • Phone: 304-797-6404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number12829
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: