Provider Demographics
NPI:1053343574
Name:FEFER, SERGIO D (MD)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:D
Last Name:FEFER
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 1:780 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:S WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1622
Mailing Address - Country:US
Mailing Address - Phone:781-331-4600
Mailing Address - Fax:781-337-5095
Practice Address - Street 1:780 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1622
Practice Address - Country:US
Practice Address - Phone:781-331-4600
Practice Address - Fax:781-337-5095
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228965174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3832495OtherCIGNA
MA0039435OtherNEIGHBORHOOD HEALTH PLAN
MA2123177Medicaid
MAJ40384OtherBLUE SHIELD
MA466687OtherTUFTS HEALTH PLAN
MA117694OtherFALLON
MAAA69245OtherHARVARD PILGRIM
MA3832495OtherCIGNA
MAI58514Medicare UPIN