Provider Demographics
NPI:1295818201
Name:FELDMANN, MARK ERNST JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ERNST
Last Name:FELDMANN
Suffix:JR
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 1:1 RIVERSIDE CIRCLE, SUITE 300
Mailing Address - Street 2:CARILION CLINIC
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016
Mailing Address - Country:US
Mailing Address - Phone:540-581-0180
Mailing Address - Fax:
Practice Address - Street 1:1 RIVERSIDE CIR STE 300
Practice Address - Street 2:SUITE 300
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4962
Practice Address - Country:US
Practice Address - Phone:540-581-0180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL24528208600000X
VA01012458292086S0122X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program