Provider Demographics
NPI:1154583565
Name:FELD, MARK J (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:FELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 OLD COURT RD STE 7
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3901
Mailing Address - Country:US
Mailing Address - Phone:443-927-6359
Mailing Address - Fax:
Practice Address - Street 1:3701 OLD COURT RD
Practice Address - Street 2:SUITE 7
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3909
Practice Address - Country:US
Practice Address - Phone:443-927-6359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2018-09-27
Deactivation Date:2016-04-04
Deactivation Code:
Reactivation Date:2016-09-16
Provider Licenses
StateLicense IDTaxonomies
MDD0044737202C00000X
MDD447372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner