Active NPI
David L Fellenbaum, PAC
- Nephrology Physician
- Philadelphia, PA
National Provider Identifier
1184707895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- MH000179L
- Practice address
- 235 N Broad St
Suite 200 Clinical Nephrology Assoc
Philadelphia, PA 19107-1511 - Phone
- (215) 762-7785
- Fax
- (215) 568-6007
- NPI assigned
- Oct 24, 2006
- Last updated
- Sep 21, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | MH000179L | PA | Primary |
Addresses
Primary practice location
235 N Broad St
Suite 200 Clinical Nephrology Assoc
Philadelphia, PA 19107-1511
Mailing address
235 N Broad St
Suite 200
Philadelphia, PA 19107-1511
Phone (215) 762-7785
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH000179L | PA | MD | Nephrology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285027200000",
"number": "1184707895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "235 N BROAD ST",
"address_2": "SUITE 200",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191071511",
"telephone_number": "215-762-7785",
"fax_number": "215-568-6007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "235 N BROAD ST",
"address_2": "SUITE 200 CLINICAL NEPHROLOGY ASSOC",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191071511",
"telephone_number": "215-762-7785",
"fax_number": "215-568-6007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FELLENBAUM",
"first_name": "DAVID",
"middle_name": "L",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2010-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "PA",
"license": "MH000179L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.