1346564820 NPI number — MARVIN A FELDSTEIN MD INC

Table of content: (NPI 1346564820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346564820 NPI number — MARVIN A FELDSTEIN MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARVIN A FELDSTEIN MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346564820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8224 MENTOR AVE
Provider Second Line Business Mailing Address:
STE 146
Provider Business Mailing Address City Name:
MENTOR
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44060-5768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-255-3555
Provider Business Mailing Address Fax Number:
440-255-4959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8224 MENTOR AVE
Provider Second Line Business Practice Location Address:
STE 146
Provider Business Practice Location Address City Name:
MENTOR
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44060-5768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-255-3555
Provider Business Practice Location Address Fax Number:
440-255-4959
Provider Enumeration Date:
03/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FELDSTEIN
Authorized Official First Name:
MARVIN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
440-255-3555

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35026484F , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2692831 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000164017 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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