Provider Demographics
NPI:1003074691
Name:FELDMAN, MARY S (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:S
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:3170 KETTERING BLVD
Mailing Address - Street 2:BLDG B 3RD FL
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3188
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:30 E APPLE ST STE 5254A
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409
Practice Address - Country:US
Practice Address - Phone:937-208-4200
Practice Address - Fax:937-208-4205
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2019-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH166662084A2900X, 2084N0400X
NHLT41362084N0400X
OH34.0126422084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102380162Medicaid
OH0217667Medicaid