Healthcare Provider Details

I. General information

NPI: 1154583565
Provider Name (Legal Business Name): MARK J FELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date: 04/04/2016
Reactivation Date: 09/16/2016

III. Provider practice location address

3701 OLD COURT RD SUITE 7
BALTIMORE MD
21208-3909
US

IV. Provider business mailing address

3701 OLD COURT RD STE 7
BALTIMORE MD
21208-3901
US

V. Phone/Fax

Practice location:
  • Phone: 443-927-6359
  • Fax:
Mailing address:
  • Phone: 443-927-6359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License NumberD0044737
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: