Provider Demographics
NPI:1407856172
Name:FELDMANN, SPENCER G (MD)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:G
Last Name:FELDMANN
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 1:8580 MAGELLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1149
Mailing Address - Country:US
Mailing Address - Phone:434-348-4680
Mailing Address - Fax:434-336-1003
Practice Address - Street 1:511 BELFIELD DR
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1217
Practice Address - Country:US
Practice Address - Phone:434-348-4680
Practice Address - Fax:434-336-1003
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1407856172Medicaid
VA5601169Medicaid
VA1407856172Medicaid
B05004Medicare UPIN
VAVAA113266Medicare PIN