Provider Demographics
NPI:1770527392
Name:FELDMAN, JACQUELINE M (MD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:FELDMAN
Suffix:
Gender:F
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:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-934-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL154482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051598190OtherBLUE CROSS
AL051065548OtherBLUE CROSS
AL051501376OtherBC FEDERAL EHBP
AL051598188OtherBLUE CROSS
ALC85366OtherVIVA
AL000082852Medicaid
AL051598189OtherBLUE CROSS
AL260013181OtherRAILROAD MEDICARE
AL000082852OtherBLUE CROSS
AL330500211OtherMEDICAID REHAB
AL051065548OtherBLUE CROSS