MEDICARE: CHRISTOPHER CHARLES FEDERER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207U00000X	Nuclear Medicine Physician	040565	OH

General Provider Information

NPI Number	:	1386116473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER CHARLES FEDERER

Provider Business Mailing Address
First Line	:	1570 PRESTON AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44305-3546
Country	:	US
Telephone Number	:	843-412-9965
Fax Number	:

Provider Business Practice Location Address
First Line	:	1570 PRESTON AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44305-3546
Country	:	US
Telephone Number	:	843-412-9965
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2018
Last Update Date	:	12/30/2018

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Directions to “ CHRISTOPHER CHARLES FEDERER ” Practice Location

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