Provider Demographics
NPI:1336254424
Name:FELDMAN, MARVIN JACK (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:JACK
Last Name:FELDMAN
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 1:227 ST PAUL PLACE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2001
Mailing Address - Country:US
Mailing Address - Phone:410-783-5858
Mailing Address - Fax:410-783-5864
Practice Address - Street 1:227 ST PAUL PLACE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2001
Practice Address - Country:US
Practice Address - Phone:410-783-5858
Practice Address - Fax:410-783-5864
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD07930207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD308341100Medicaid
124054OtherAETNA
39974701OtherCAREFIRST MD
R8440001OtherCAREFIRST DC
39974701OtherCAREFIRST MD
MD123L910AMedicare ID - Type Unspecified