Provider Demographics
NPI:1619983590
Name:FEIT, THEODORE STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:STUART
Last Name:FEIT
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 1:2601 W ALAMEDA AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4800
Mailing Address - Country:US
Mailing Address - Phone:818-636-6463
Mailing Address - Fax:818-345-3533
Practice Address - Street 1:2601 W ALAMEDA AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4800
Practice Address - Country:US
Practice Address - Phone:818-636-6463
Practice Address - Fax:818-345-3533
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32804174400000X, 293D00000X
CAG302804261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G328040Medicaid
CAG32804Medicare ID - Type Unspecified
CAA89535Medicare UPIN