Healthcare Provider Details

I. General information

NPI: 1295780047
Provider Name (Legal Business Name): GEORGE MICHAEL FELDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

451 DOVER KNOLL RD
MANAKIN VA
23103-3117
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5596
  • Fax: 804-675-5344
Mailing address:
  • Phone: 804-784-3454
  • Fax: 804-675-5344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101045549
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG34186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: