Provider Demographics
NPI:1760560494
Name:FEINBERG, BENNETT (MD)
Entity Type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:
Last Name:FEINBERG
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 1:300 PRISON RD
Mailing Address - Street 2:MEDICAL OFFICES - FOLSOM STATE PRISON
Mailing Address - City:REPRESA
Mailing Address - State:CA
Mailing Address - Zip Code:95671-3001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 PRISON RD
Practice Address - Street 2:MEDICAL OFFICES - FOLSOM STATE PRISON
Practice Address - City:REPRESA
Practice Address - State:CA
Practice Address - Zip Code:95671-3001
Practice Address - Country:US
Practice Address - Phone:916-985-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63579207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A635790Medicaid
G96341Medicare UPIN
CA00A635790Medicaid