Provider Demographics
NPI:1528142353
Name:FEINERMAN, BRUCE I (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:I
Last Name:FEINERMAN
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 1:1645 LIBERTY RD STE 205
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6542
Mailing Address - Country:US
Mailing Address - Phone:410-795-7300
Mailing Address - Fax:
Practice Address - Street 1:1645 LIBERTY RD STE 205
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6542
Practice Address - Country:US
Practice Address - Phone:410-795-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0032652208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE25328Medicare UPIN