Provider Demographics
NPI:1346564820
Name:MARVIN A FELDSTEIN MD INC
Entity Type:Organization
Organization Name:MARVIN A FELDSTEIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FELDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-255-3555
Mailing Address - Street 1:8224 MENTOR AVE
Mailing Address - Street 2:STE 146
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5768
Mailing Address - Country:US
Mailing Address - Phone:440-255-3555
Mailing Address - Fax:440-255-4959
Practice Address - Street 1:8224 MENTOR AVE
Practice Address - Street 2:STE 146
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5768
Practice Address - Country:US
Practice Address - Phone:440-255-3555
Practice Address - Fax:440-255-4959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35026484F207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2692831Medicaid
000000164017OtherANTHEM BLUE CROSS BLUE SHIELD
OH2692831Medicaid
OH0131551Medicare PIN