Provider Demographics
NPI:1306817440
Name:FELDMAN, DAVID BORDEN (DAVID FELDMAN MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BORDEN
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DAVID FELDMAN MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34950 CHARDON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9162
Mailing Address - Country:US
Mailing Address - Phone:440-510-5100
Mailing Address - Fax:440-510-5151
Practice Address - Street 1:34950 CHARDON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9162
Practice Address - Country:US
Practice Address - Phone:440-510-5100
Practice Address - Fax:440-510-5151
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051850F2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0672535Medicaid
A16110Medicare UPIN
FE0568802Medicare ID - Type Unspecified