Individual provider Active NPI

Tatiana Fedorova, MD

  • Surgery Physician
  • Baltimore, MD
National Provider Identifier
1881121093
Registry record updated Jun 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
D0094106 Issued in MD
Practice address
1800 Orleans St
Baltimore, MD 21287-0010
Phone
(410) 955-5000
NPI assigned
May 18, 2017
Last updated
Jun 7, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 4301111892 MI
Surgery Physician 208600000X D0094106 MD Primary

Addresses

Primary practice location

1800 Orleans St
Baltimore, MD 21287-0010

Mailing address

1800 Orleans St
Baltimore, MD 21287-0010

Other practice location 1

22151 Moross Rd Ste 214
Detroit, MI 48236-2151
Phone (313) 343-4867

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230831002374 NY Practitioner - General Surgery 0941577886 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

169 Riveride Dr
Binghamton, NY 13905-4246
Phone (607) 352-3550

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0094106MDMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of Lourdes Memorial Hospital, Inc. Surgery Current Accepting new patients
Our Lady of Lourdes Memorial Hospital Inc. CurrentSince Aug 1, 2023 Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. CurrentSince Aug 1, 2023 Accepting new patients
Twin Tier Pathology Associates, PC Current Accepting new patients

Locations

169 Riverside Dr
Binghamton, NY 13905
Phone (607) 798-5111

169 Riverside Dr
Ste 206
Binghamton, NY 13905
Phone (607) 798-6701

500 5th Ave
Owego, NY 13827
Phone (607) 687-1122

Interoperability endpoints

  • Direct secure messaging: tfedorova196837@direct-guthrie.org
  • Direct secure messaging: tfedorova990062@direct.hopkinsmedicine.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1495065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654560000000",
    "number": "1881121093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 ORLEANS ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212870010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 ORLEANS ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212870010",
            "telephone_number": "410-955-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22151 Moross Rd Ste 214",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482362151",
            "country_code": "US",
            "telephone_number": "313-343-4867",
            "fax_number": "313-343-3280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FEDOROVA",
        "first_name": "TATIANA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-18",
        "last_updated": "2022-06-07",
        "certification_date": "2022-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4301111892",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MD",
            "license": "D0094106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.