Basic Information
| Provider Information | |||||||||
| NPI: | 1659401131 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FEIRTAG | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | JOEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17296 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212971296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015728340 | ||||||||
| FaxNumber: | 3015728403 | ||||||||
| Practice Location | |||||||||
| Address1: | 3110 GRACEFIELD RD | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209041820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015728340 | ||||||||
| FaxNumber: | 3015728403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 07/16/2009 | ||||||||
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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 | 207RG0300X | D0023855 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0054 | 01 | CAREFIRST BCBS | OTHER | 0943ER-311120-02 | 01 | CAREFIRST BCBS OF MD | OTHER | 311120-02 | 01 | BCBS MD | OTHER | P17416 | 01 | BCBS DC | OTHER | 04-21635 | 01 | EVERCARE | OTHER | 312031700 | 05 | MD | MEDICAID |