Basic Information
| Provider Information | |||||||||
| NPI: | 1740253772 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELDSTEIN | ||||||||
| FirstName: | BRAD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1615 LIMEKILN PIKE | ||||||||
| Address2: | |||||||||
| City: | DRESHER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190251053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156437331 | ||||||||
| FaxNumber: | 2156540741 | ||||||||
| Practice Location | |||||||||
| Address1: | 1615 LIMEKILN PIKE | ||||||||
| Address2: | |||||||||
| City: | DRESHER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190251053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156437331 | ||||||||
| FaxNumber: | 2156540741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2006 | ||||||||
| LastUpdateDate: | 05/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD028590E | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 00161847900008 | 05 | PA | MEDICAID |