MEDICARE: BRYAN N FELDMAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34-00-5518	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376578559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN N FELDMAN D.O.

Provider Business Mailing Address
First Line	:	6100 EAST MAIN STREET
Second Line	:	SUITE 105
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3399
Country	:	US
Telephone Number	:	614-626-0722
Fax Number	:	614-626-0747

Provider Business Practice Location Address
First Line	:	6100 EAST MAIN STREET
Second Line	:	SUITE 105
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3399
Country	:	US
Telephone Number	:	614-626-0722
Fax Number	:	614-626-0747

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/09/2016

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