Provider Demographics
NPI:1972508612
Name:FEINBERG, MICHAEL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:FEINBERG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 MCCALLUM ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2936
Mailing Address - Country:US
Mailing Address - Phone:215-248-0980
Mailing Address - Fax:
Practice Address - Street 1:11 BALA AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3201
Practice Address - Country:US
Practice Address - Phone:215-327-1565
Practice Address - Fax:610-664-5599
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-035853-E2084P0800X
MI43010340212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1053573Medicaid
PA1053573Medicaid
PAC33834Medicare UPIN