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NPI Code Detail

MEDICARE: JONATHAN CARL FELLERS MD

MEDICARE: JONATHAN CARL FELLERS MD
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
1202C00000XIndependent Medical Examiner PhysicianMD20613ME
22083A0300XAddiction Medicine (Preventive Medicine) PhysicianMD20613ME
32084P0800XPsychiatry PhysicianMD20613ME
42084P0802XAddiction Psychiatry PhysicianMD20613ME

General Provider Information

NPI Number : 1508091281
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN CARL FELLERS MD
Provider Business Mailing Address
First Line : 1 CITY CTR STE 8130
Second Line :
City : PORTLAND
State : ME
Zip : 04101-6420
Country : US
Telephone Number : 207-221-0635
Fax Number : 207-221-0634
Provider Business Practice Location Address
First Line : 1 CITY CTR STE 8130
Second Line :
City : PORTLAND
State : ME
Zip : 04101-6420
Country : US
Telephone Number : 207-221-0635
Fax Number : 207-221-0634
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2009
Last Update Date : 08/22/2025

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