Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 35086042 | OH |
NPI | 1114003332 |
---|---|
Provider Name | Jennifer Michele Feldman |
First Address | Dayton, OH 45415-1185 |
Second Address | Dayton, OH 45415-1185 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000370260 | BLUE CROSS BLUE SHIELD (01) | |
1205522 | UNITED HEALTHCARE (01) | |
2626644 | (05) | OH |
7314721 | AETNA (01) |