Provider Demographics
NPI:1881696565
Name:FELDMAN, MARK SAMUEL (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:SAMUEL
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 39209
Mailing Address - Street 2:
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339
Mailing Address - Country:US
Mailing Address - Phone:954-851-9966
Mailing Address - Fax:954-318-7360
Practice Address - Street 1:850 S. PINE ISLAND RD.
Practice Address - Street 2:STE. A100
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:954-741-5555
Practice Address - Fax:954-741-6298
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0009731174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL202305OtherCOMPBENEFITS CORPORATION
FL650560968OtherUNITED
FL043728000Medicaid
FL2511309OtherAETNA
FL650560968OtherHUMANA
FL44056OtherBLUE CROSS BLUE SHEILD
FL180042798OtherRAIL ROAD MEDICARE
FL202305OtherAVMED
FL650560968OtherCIGNA
FL043728000Medicaid
FL650560968OtherUNITED
FL202305OtherCOMPBENEFITS CORPORATION