Provider Demographics
NPI:1477143733
Name:FELDHAMMER, MATTHEW (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:FELDHAMMER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 W 8TH ST # C504
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6511
Mailing Address - Country:US
Mailing Address - Phone:904-244-5076
Mailing Address - Fax:
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-5076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1225246QC1000X
246QI0000X, 246QL0901X, 246ZB0500X
FLDL49402247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
No246QC1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyChemistry
No246QI0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyImmunology
No246QL0901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management, Diplomate
No246ZB0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherBiochemist