Healthcare Provider Details

I. General information

NPI: 1538250337
Provider Name (Legal Business Name): JEFFREY FELDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WELLS ST STE. 201
WESTERLY RI
02891-2923
US

IV. Provider business mailing address

17 WELLS ST STE. 201
WESTERLY RI
02891-2923
US

V. Phone/Fax

Practice location:
  • Phone: 401-596-2033
  • Fax: 401-596-9294
Mailing address:
  • Phone: 401-596-2033
  • Fax: 401-596-9294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD07940
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: