| Doctor Name: | MICHAEL JOHN FEDOR |
| NPI Number: | 1477647899 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NURSE PRACTITIONER |
| License Number: | 26NJ00086500 |
| Business Practice Address: | 90 Vandenberg Dr 66th Medical Group Hanscom Afb, MA - 01731 |
| Business Phone Number: | 7813776926 |
| Business Fax Number: | |
| Mailing Address: | 100 Patterson Rd, HANSCOM AFB |
| State: | MA |
| Postal Code: | 017312651 |
| Phone Number: | 7818632671 |
| Fax Number: | |
| NPI Enumeration Date: | 10/02/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 26NJ00086500 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |