Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | LL24528 | SC |
N | 208600000X | Surgeon | LL24528 | SC |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 0101245829 | VA |
NPI | 1295818201 |
---|---|
Provider Name | Dr. Mark Ernst Feldmann JR. |
First Address | Roanoke, VA 24016 |
Second Address | Roanoke, VA 24016-4962 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 28/06/2012 |