Provider Demographics
NPI:1841479623
Name:FEINMAN, MITCHELL CRAIG (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:CRAIG
Last Name:FEINMAN
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 1:1768 VILLAGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2457
Mailing Address - Country:US
Mailing Address - Phone:803-539-2224
Mailing Address - Fax:803-539-2234
Practice Address - Street 1:1768 VILLAGE PARK DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2457
Practice Address - Country:US
Practice Address - Phone:803-539-2224
Practice Address - Fax:803-539-2234
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18391207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT24499Medicaid
SCF296629265Medicare PIN
F296620281Medicare PIN
SCT24499Medicaid