Provider Demographics
NPI:1275758781
Name:ELLIOT D FELMAN MD
Entity Type:Organization
Organization Name:ELLIOT D FELMAN MD
Other - Org Name:ELLIOT D FELMAN MD APC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:D
Authorized Official - Last Name:FELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-206-2525
Mailing Address - Street 1:1304 15TH STREET
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-260-2525
Mailing Address - Fax:310-260-7575
Practice Address - Street 1:1304 15TH STREET
Practice Address - Street 2:SUITE 310
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-260-2525
Practice Address - Fax:310-260-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40377Medicare UPIN
W8614Medicare PIN