Provider Demographics
NPI:1194715110
Name:FELDMAN, JOHN D (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:FELDMAN
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 1:780 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1622
Mailing Address - Country:US
Mailing Address - Phone:781-331-4600
Mailing Address - Fax:781-337-5095
Practice Address - Street 1:780 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1622
Practice Address - Country:US
Practice Address - Phone:781-331-4600
Practice Address - Fax:781-337-5095
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57724174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0012673OtherNEIGHBORHOOD HEALTH PLAN
MA4232596OtherUS HEALTHCARE
MA34751OtherFALLON
MA1900015OtherUNITED HEALTHCARE
MD057724OtherTUFTS
MA9718672Medicaid
MA0122416001OtherCIGNA
MAJ11492OtherBLUE SHIELD
MA27154OtherHARVARD PILGRIM
MAE95648Medicare UPIN