Provider Demographics
NPI:1235106097
Name:FEUERSTEIN, BRANDT J (MD)
Entity Type:Individual
Prefix:
First Name:BRANDT
Middle Name:J
Last Name:FEUERSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BANNING ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3488
Mailing Address - Country:US
Mailing Address - Phone:302-735-8850
Mailing Address - Fax:302-735-8851
Practice Address - Street 1:200 BANNING ST
Practice Address - Street 2:STE 300
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3488
Practice Address - Country:US
Practice Address - Phone:302-735-8850
Practice Address - Fax:302-735-8851
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-006274208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001124601Medicaid
DE1235106097OtherNPI
H43589Medicare UPIN