Provider Demographics
NPI:1376578559
Name:FELDMAN, BRYAN N (DO)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:N
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 EAST MAIN STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3399
Mailing Address - Country:US
Mailing Address - Phone:614-626-0722
Mailing Address - Fax:614-626-0747
Practice Address - Street 1:6100 EAST MAIN STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-3399
Practice Address - Country:US
Practice Address - Phone:614-626-0722
Practice Address - Fax:614-626-0747
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-5518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0889212Medicaid
OH0726236Medicare PIN
OH0889212Medicaid