Basic Information
| Provider Information | |||||||||
| NPI: | 1730308545 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARTIN A FELDMAN DO PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3229 E GREENWAY RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850324508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029423750 | ||||||||
| FaxNumber: | 6029424245 | ||||||||
| Practice Location | |||||||||
| Address1: | 3229 E GREENWAY RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850324508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029423750 | ||||||||
| FaxNumber: | 6029424245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FELDMAN | ||||||||
| AuthorizedOfficialFirstName: | MARTIN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6029423750 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2104 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | AZ0062880 | 01 | AZ | BCBS OF AZ | OTHER | 265711 | 05 | AZ | MEDICAID | F00334 | 05 | AZ | MEDICAID | PFP13FELDMA1 | 05 | AZ | MEDICAID |