Provider Demographics
NPI:1003965641
Name:SANFORD G FELDMAN MD INC
Entity type:Organization
Organization Name:SANFORD G FELDMAN MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:G
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-273-0200
Mailing Address - Street 1:3737 MORAGA AVE
Mailing Address - Street 2:SUITE A105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5404
Mailing Address - Country:US
Mailing Address - Phone:858-273-0200
Mailing Address - Fax:858-273-0619
Practice Address - Street 1:3737 MORAGA AVE
Practice Address - Street 2:SUITE A105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5404
Practice Address - Country:US
Practice Address - Phone:858-273-0200
Practice Address - Fax:858-273-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G456270Medicaid
00G456270OtherBLUE CROSS BLUE SHIELD
00G456270OtherBLUE CROSS BLUE SHIELD
CAW15232Medicare PIN