Basic Information
| Provider Information | |||||||||
| NPI: | 1417245101 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FEELEY | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 655 COLUMBIA ST UNIT 208 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921016744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087778455 | ||||||||
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| Practice Location | |||||||||
| Address1: | 615 N WOLFE ST STE WB602 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212052103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109553630 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2011 | ||||||||
| LastUpdateDate: | 10/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | 152340 | CA | N | Other Service Providers | Military Health Care Provider | 390200000X | MT200277 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208D00000X | C152340 | CA | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.