Healthcare Provider Details

I. General information

NPI: 1831280841
Provider Name (Legal Business Name): ELLEN K FELDMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 S COLUMBIA RD
GRAND FORKS ND
58201-4028
US

IV. Provider business mailing address

PO BOX 6002
GRAND FORKS ND
58206-6002
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-6697
  • Fax:
Mailing address:
  • Phone: 701-780-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number7664
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: