Provider Demographics
NPI:1174581706
Name:FELLER, CLIFFORD W (MD)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:W
Last Name:FELLER
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 1:148 EAST AVENUE
Mailing Address - Street 2:STE 1E
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851
Mailing Address - Country:US
Mailing Address - Phone:203-838-9898
Mailing Address - Fax:203-866-1703
Practice Address - Street 1:148 EAST AVENUE
Practice Address - Street 2:STE 1E
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:203-838-9898
Practice Address - Fax:203-866-1703
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14386207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT32909OtherEMPIRE BCBS
CT00114386600OtherBLUE CARE FAMILY PLAN
CT020014OtherHNET
CT2P109OtherOXFORD
CT44020556OtherMULTIPLAN
CT314386OtherCONNECTI CARE
CT564078OtherAETNA HEALTH CARE
CT010014386CT01OtherANTHEM BLUE CROSS BLUE SH
CT32909OtherEMPIRE BCBS