MEDICARE: MARVIN A FELDSTEIN MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35026484F	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000164017	OTHER		ANTHEM BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1346564820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARVIN A FELDSTEIN MD INC

Provider Business Mailing Address
First Line	:	8224 MENTOR AVE
Second Line	:	STE 146
City	:	MENTOR
State	:	OH
Zip	:	44060-5768
Country	:	US
Telephone Number	:	440-255-3555
Fax Number	:	440-255-4959

Provider Business Practice Location Address
First Line	:	8224 MENTOR AVE
Second Line	:	STE 146
City	:	MENTOR
State	:	OH
Zip	:	44060-5768
Country	:	US
Telephone Number	:	440-255-3555
Fax Number	:	440-255-4959

Authorized Official
Title or Position	:	OWNER
Name	:	MARVIN A FELDSTEIN
Credential	:	MD
Telephone Number	:	440-255-3555

Provider Enumeration Date	:	03/26/2010
Last Update Date	:	04/07/2010

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