Provider Demographics
NPI:1659401131
Name:FEIRTAG, DANIEL JOEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOEL
Last Name:FEIRTAG
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 17296
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1296
Mailing Address - Country:US
Mailing Address - Phone:301-572-8340
Mailing Address - Fax:301-572-8403
Practice Address - Street 1:3110 GRACEFIELD RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1820
Practice Address - Country:US
Practice Address - Phone:301-572-8340
Practice Address - Fax:301-572-8403
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023855207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0054OtherCAREFIRST BCBS
0943ER-311120-02OtherCAREFIRST BCBS OF MD
311120-02OtherBCBS MD
P17416OtherBCBS DC
04-21635OtherEVERCARE
MD312031700Medicaid
P17416OtherBCBS DC
MD312031700Medicaid
130389ZAG0Medicare PIN