Basic Information
| Provider Information | |||||||||
| NPI: | 1336254424 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FELDMAN | ||||||||
| FirstName: | MARVIN | ||||||||
| MiddleName: | JACK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 227 ST PAUL PLACE | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212022001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107835858 | ||||||||
| FaxNumber: | 4107835864 | ||||||||
| Practice Location | |||||||||
| Address1: | 227 ST PAUL PLACE | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212022001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107835858 | ||||||||
| FaxNumber: | 4107835864 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | D07930 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 308341100 | 05 | MD | MEDICAID | 124054 | 01 | AETNA | OTHER | 39974701 | 01 | CAREFIRST MD | OTHER | R8440001 | 01 | CAREFIRST DC | OTHER |