1679590574 NPI number — ROBERT C. FELDMAN, MD, PA

Table of content: JASON EUGENE BENNETT MSPT SCS ATC (NPI 1609987650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679590574 NPI number — ROBERT C. FELDMAN, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT C. FELDMAN, MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679590574
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15005 SHADY GROVE RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-6340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-279-9696
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15005 SHADY GROVE RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-6340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-279-9696
Provider Business Practice Location Address Fax Number:
301-251-5454
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
FLORENCIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SUPERVISOR
Authorized Official Telephone Number:
301-279-9696

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 264302200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: KQ33 . This is a "BCBS OF MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: A565 . This is a "BCBS NCA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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