Healthcare Provider Details

I. General information

NPI: 1255548558
Provider Name (Legal Business Name): MARCIA VICTORIA FELKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCIA VICTORIA MCCANN MD

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR STE 1340 RILEY HOSPITAL CHILD NEUROLOGY
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-948-7450
  • Fax: 317-948-3408
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01064161A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number11012047A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number01064161A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number01064161A
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01064161A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: