=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154900298
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. JOSHUA ADAM FEDER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2021
-----------------------------------------------------
Last Update Date | 04/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 SMYTH ROAD
-----------------------------------------------------
City | OTTAWA
-----------------------------------------------------
State | ONTARIO
-----------------------------------------------------
Zip | K1H 8L1
-----------------------------------------------------
Country | CA
-----------------------------------------------------
Telephone | 613-737-7600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 755 PLACE STEWART
-----------------------------------------------------
City | MONTREAL
-----------------------------------------------------
State | QUEBEC
-----------------------------------------------------
Zip | H4M 2X2
-----------------------------------------------------
Country | CA
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 115025
-----------------------------------------------------
License Number State | ZZ
-----------------------------------------------------