Provider Demographics
NPI:1457346975
Name:FELDENZER, JOHN A (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:FELDENZER
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:RR 2 BOX 169E
Mailing Address - Street 2:DAWKINS DRIVE
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9390
Mailing Address - Country:US
Mailing Address - Phone:304-645-8095
Mailing Address - Fax:304-645-8094
Practice Address - Street 1:RR 2 BOX 169E
Practice Address - Street 2:DAWKINS DRIVE
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9390
Practice Address - Country:US
Practice Address - Phone:304-645-8095
Practice Address - Fax:304-645-8094
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043696207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010019303Medicaid
VA010022681Medicaid
VAE04372Medicare UPIN
P00086761Medicare PIN
VA010022681Medicaid