MARK FEDDER, MD, PC (NPI# 1184806101) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184806101 |
| Entity Type | Organization |
| Organization Name | MARK FEDDER, MD, PC |
| Practice Address |
6810 State Route 162 Suite 211 Maryville IL 62062-8501 |
| Practice Telephone | 6182880346 |
| Practice Fax Number | 6182880349 |
| Mailing Telephone | 6182880346 |
| Mailing Fax Number | 6182880349 |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2007-11-30 |
| Authorized Official Name | DR. MARK STEPHEN FEDDER (OWNER/PRESIDENT) |
| Authorized Official Telephone | 6182880346 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
IL | Allopathic & Osteopathic Physicians |
| Street Address |
6810 STATE ROUTE 162 SUITE 211 |
| City | MARYVILLE |
| State | IL |
| Zip Code | 62062-8501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922009943 | Mark Stephen Fedder | Internal Medicine | 6810 State Route 162, Suite 211, Maryville, IL 62062-8501 | 2005-08-02 |
| 1003295213 | Msa Alliance, LLC Dba-southern Illinois Vascular and Vein Surgery | Surgery | 6810 State Route 162, Suite 100, Maryville, IL 62062 | 2015-05-20 |
| 1467867234 | Premier Foot and Ankle of Illinois, PC | Podiatrist | 6810 State Route 162, Suite 20, Maryville, IL 62062-8587 | 2014-06-30 |
| 1043521719 | Gabriel Cardenas Jr. | Podiatrist | 6810 State Route 162, Suite 20, Maryville, IL 62062-8587 | 2010-06-28 |
| 1780818831 | Patricia Renee Verdu | Registered Nurse | 6810 State Route 162, Maryville, IL 62062-8501 | 2009-05-04 |
| 1518143254 | James J. Dalla Riva, Md, PC | Specialist | 6810 State Route 162, Suite 301, Maryville, IL 62062-8501 | 2008-01-11 |
| 1518178730 | Melissa Ann Kershaw | Internal Medicine | 6810 State Route 162, Ste 102, Maryville, IL 62062-8501 | 2007-05-28 |
| 1710009840 | James W. Lane | Psychologist | 6810 State Route 162, Suite 215, Maryville, IL 62062-8501 | 2007-04-06 |
| 1245373489 | Fairview Heights Medical Group Sc | Internal Medicine | 6810 State Route 162, Suite 203, Maryville, IL 62062-8501 | 2007-02-15 |
| 1659423085 | Ursula Louise Thatch | Obstetrics & Gynecology | 6810 State Route 162, Ste 100, Maryville, IL 62062-8501 | 2007-01-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104325091 | Jennifer M Oyler | Physician Assistant | 6812 State Route 162 Suite 120, Maryville, IL 62062 | 2018-02-06 |
| 1710495965 | Sarah Elizabeth Barto | Family Medicine | 2133 Vadalabene Drive, Suite Sb, Maryville, IL 62062 | 2018-01-22 |
| 1104348085 | Lindsey Nicole Langendorf | Chiropractor | 62 Executive Plaza Ct, Maryville, IL 62062 | 2017-07-12 |
| 1043750540 | Gina Saal | Nurse Anesthetist, Certified Registered | 6800 Rt 162, Maryville, IL 62062 | 2017-03-02 |
| 1548657737 | Karen Michelle Bertels | Emergency Medicine | 6800 Il - 162, Maryville, IL 62062 | 2015-04-25 |
| 1811258148 | Debra Ann Hoelscher | Internal Medicine | 2102 Vadalabene, Maryville, IL 62062 | 2012-06-04 |
| 1538438445 | Casey Elizabeth Wiesemeyer | Speech-Language Pathologist | 2201 Copper Creek Rd, Maryville, IL 62062 | 2011-12-21 |
| 1407144819 | Norah Claire Farley Baker | Family Medicine | 10 Professional Park Dr., Maryville, IL 62062 | 2011-07-19 |
| 1891092474 | Kimberly M Schneider | Physician Assistant | 20b Professional Park Drive, Maryville, IL 62062 | 2011-02-17 |
| 1669782397 | Purandhri Patel | Physical Therapist | 6820 State Route 162, Maryville, IL 62062 | 2010-10-15 |
| Find all providers in zip 62062 | ||||
| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750364782 | William Elwyn Lyles | Internal Medicine | 355 Bmh Physicians Office Bldg, Maryville, TN 37804-5820 | 2005-11-23 |
| 1922009943 | Mark Stephen Fedder | Internal Medicine | 6810 State Route 162, Suite 211, Maryville, IL 62062-8501 | 2005-08-02 |
| 1245592823 | Isaac W Cline | Internal Medicine | 1706 E Lamar Alexander Pkwy, Maryville, TN 37804-6204 | 2012-06-11 |
| 1912117912 | Edmundo Alejandro Rodriguez | Internal Medicine | 6812 State Route 162, Suite 204, Maryville, IL 62062 | 2007-05-22 |
| 1912115460 | Jenny Owens Smith | Internal Medicine | 1706 E Lamar Alexander Pkwy, Maryville, TN 37804-6204 | 2007-05-18 |
| 1306938048 | Ravindra Murthy | Internal Medicine | 355 Bmh Physicians Office Bldg, Maryville, TN 37804-5820 | 2006-09-29 |
| 1144286709 | Blount Gastroenterology Assoc PC | Internal Medicine | 1706 E Lamar Alexander Pkwy, Maryville, TN 37804-6204 | 2006-04-24 |
| 1689638884 | Frank David Wright | Internal Medicine | 355 Bmh Physicians Office Bldg, Maryville, TN 37804-5820 | 2006-04-14 |
| 1225091564 | Michael John Coffey | Internal Medicine | 1706 E Lamar Alexander Pkwy, Maryville, TN 37804-6204 | 2006-04-08 |
| 1942263280 | Richard Glen Cline | Internal Medicine | 1706 E Lamar Alexander Pkwy, Maryville, TN 37804-6204 | 2006-04-08 |
| Find all providers in MARYVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.