Provider Demographics
NPI:1801945357
Name:FELDMAN, SANFORD G (MD)
Entity type:Individual
Prefix:
First Name:SANFORD
Middle Name:G
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 1:3737 MORAGA AVE
Mailing Address - Street 2:SUITE A105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5404
Mailing Address - Country:US
Mailing Address - Phone:858-273-0200
Mailing Address - Fax:858-273-0619
Practice Address - Street 1:3737 MORAGA AVE
Practice Address - Street 2:SUITE A105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5404
Practice Address - Country:US
Practice Address - Phone:858-273-0200
Practice Address - Fax:858-273-0619
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45627207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G456270OtherBLUE CROSS BLUE SHIELD
CA00G456270Medicaid
A50121Medicare UPIN
00G456270OtherBLUE CROSS BLUE SHIELD
CA00G456270Medicaid