Healthcare Provider Details

I. General information

NPI: 1811230410
Provider Name (Legal Business Name): ELLIOT J FEINBERG MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 ERDMAN WAY
LEOMINSTER MA
01453-1805
US

IV. Provider business mailing address

105 ERDMAN WAY
LEOMINSTER MA
01453-1805
US

V. Phone/Fax

Practice location:
  • Phone: 978-537-7552
  • Fax: 978-840-4598
Mailing address:
  • Phone: 978-537-7552
  • Fax: 978-840-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number74135
License Number StateMA

VIII. Authorized Official

Name: ELLIOT J FEINBERG
Title or Position: OWNER
Credential: M.D.
Phone: 978-537-7552