Provider Demographics
NPI:1831186782
Name:FELDKIRCHER, MARY COLLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:COLLEEN
Last Name:FELDKIRCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:40 W ERIE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-3274
Mailing Address - Country:US
Mailing Address - Phone:440-350-0832
Mailing Address - Fax:440-354-7420
Practice Address - Street 1:7757 AUBURN RD STE 15
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-9604
Practice Address - Country:US
Practice Address - Phone:440-350-0832
Practice Address - Fax:440-354-7420
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.055667207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0879769Medicaid
OH0715892Medicare ID - Type Unspecified
OHF51476Medicare UPIN
OH0715891Medicare ID - Type Unspecified
OH0715893Medicare ID - Type Unspecified