Provider Demographics
NPI:1366555997
Name:FELDMAN, BARRY STEWART (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:STEWART
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 1:36 CLARK LN
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2310
Mailing Address - Country:US
Mailing Address - Phone:860-442-5565
Mailing Address - Fax:860-444-2673
Practice Address - Street 1:36 CLARK LN
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2310
Practice Address - Country:US
Practice Address - Phone:860-442-5565
Practice Address - Fax:860-444-2673
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D02433Medicare UPIN