Active NPI
Michael Richard Fetell, M.D.
- Neurology Physician
- Bala Cynwyd, PA
National Provider Identifier
1811298318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 118182
- Practice address
- 206 Lindy LN
Bala Cynwyd, PA 19004-1317 - Phone
- (305) 794-8367
- NPI assigned
- Nov 15, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 118182 | NY | Primary |
Addresses
Primary practice location
206 Lindy LN
Bala Cynwyd, PA 19004-1317
Mailing address
206 Lindy LN
Bala Cynwyd, PA 19004-1317
Phone (305) 794-8367
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 118182 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1289779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440979200000",
"number": "1811298318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "206 LINDY LN",
"city": "BALA CYNWYD",
"state": "PA",
"postal_code": "190041317",
"telephone_number": "305-794-8367"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 LINDY LN",
"city": "BALA CYNWYD",
"state": "PA",
"postal_code": "190041317",
"telephone_number": "305-794-8367"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FETELL",
"first_name": "MICHAEL",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-11-15",
"last_updated": "2015-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NY",
"license": "118182",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bala Cynwyd, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.