Basic Information
Provider Information
NPI: 1801860523
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FEUDALE
FirstName: FRANCES
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 783311
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191783311
CountryCode: US
TelephoneNumber: 4848844500
FaxNumber: 4848840699
Practice Location
Address1: 700 E BROAD ST
Address2:  
City: HAZLETON
State: PA
PostalCode: 182016835
CountryCode: US
TelephoneNumber: 5705014193
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/17/2006
LastUpdateDate: 03/03/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XOS009219LPAY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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