Provider Demographics
NPI:1457635575
Name:FELDMANN, THERESA LEA (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:LEA
Last Name:FELDMANN
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 1:22 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-5900
Mailing Address - Country:US
Mailing Address - Phone:603-893-7905
Mailing Address - Fax:603-898-6106
Practice Address - Street 1:22 MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-5900
Practice Address - Country:US
Practice Address - Phone:603-893-7905
Practice Address - Fax:603-898-6106
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10071208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE4745Medicare PIN