Provider Demographics
NPI:1598858367
Name:FELDMAN, JEFFREY STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STUART
Last Name:FELDMAN
Suffix:
Gender:M
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 349
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-0449
Mailing Address - Country:US
Mailing Address - Phone:781-729-2279
Mailing Address - Fax:781-662-4585
Practice Address - Street 1:340 MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-4661
Practice Address - Country:US
Practice Address - Phone:781-662-4560
Practice Address - Fax:781-662-4585
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72231208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ09385OtherBLUE CROSS BLUE SHIELD
MAJ09385OtherBLUE CROSS BLUE SHIELD