Provider Demographics
NPI:1730308545
Name:MARTIN A FELDMAN DO PC
Entity Type:Organization
Organization Name:MARTIN A FELDMAN DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-942-3750
Mailing Address - Street 1:3229 E GREENWAY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4508
Mailing Address - Country:US
Mailing Address - Phone:602-942-3750
Mailing Address - Fax:602-942-4245
Practice Address - Street 1:3229 E GREENWAY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4508
Practice Address - Country:US
Practice Address - Phone:602-942-3750
Practice Address - Fax:602-942-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0062880OtherBCBS OF AZ
AZ265711Medicaid
AZF00334Medicaid
AZPFP13FELDMA1Medicaid
AZF00334Medicaid