Provider Demographics
NPI:1265929939
Name:FELDBAUM, ELLIOT ANN
Entity type:Individual
Prefix:
First Name:ELLIOT
Middle Name:ANN
Last Name:FELDBAUM
Suffix:
Gender:F
Credentials:
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 829641
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-9641
Mailing Address - Country:US
Mailing Address - Phone:267-370-5285
Mailing Address - Fax:
Practice Address - Street 1:315 W STATE ST
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-3525
Practice Address - Country:US
Practice Address - Phone:152-345-1900
Practice Address - Fax:215-345-4579
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD471510207RC0000X
PAMT215766207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease