Provider Demographics
NPI:1043257819
Name:FEDI, PAOLO (MD)
Entity type:Individual
Prefix:DR
First Name:PAOLO
Middle Name:
Last Name:FEDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 DURKEE ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2989
Mailing Address - Country:US
Mailing Address - Phone:518-310-3890
Mailing Address - Fax:518-536-9066
Practice Address - Street 1:14 DURKEE ST STE 125
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2998
Practice Address - Country:US
Practice Address - Phone:518-310-3890
Practice Address - Fax:518-536-9066
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230138207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02758189Medicaid
NY1679950430OtherTYPE II NPI
NY154906Medicare UPIN