Provider Demographics
NPI:1376592295
Name:FELLER, ERIKA D (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:D
Last Name:FELLER
Suffix:
Gender:F
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:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-5446
Mailing Address - Fax:410-328-1048
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-5446
Practice Address - Fax:410-328-1048
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD62087207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1376592295Medicaid
MD405495400Medicaid
MD642651-01OtherBLUE CROSS/BLUE SHIELD
DC036521500Medicaid
MDJ450Medicare PIN
MD405495400Medicaid
DC036521500Medicaid
MD339957YY86Medicare PIN