Provider Demographics
NPI:1871579003
Name:FELDMAN, DONNA AZAM (MD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:AZAM
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:AZAM
Other - Last Name:LOGHMANEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5927 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-2218
Mailing Address - Country:US
Mailing Address - Phone:716-297-9379
Mailing Address - Fax:716-297-4638
Practice Address - Street 1:5927 MILITARY RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-2218
Practice Address - Country:US
Practice Address - Phone:716-297-9379
Practice Address - Fax:716-297-4638
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02686428Medicaid
NY077041Medicare Oscar/Certification
NYRA8710Medicare PIN
NY02686428Medicaid