Provider Demographics
NPI:1366416877
Name:FEASTER, RAY (MD)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:FEASTER
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:980-302-3050
Mailing Address - Fax:980-302-3055
Practice Address - Street 1:1942 E 7TH ST STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2418
Practice Address - Country:US
Practice Address - Phone:704-384-7085
Practice Address - Fax:704-384-7089
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01519207R00000X, 208M00000X
SC26098207R00000X
NC0101260000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC260988Medicaid
NC2007-01519OtherSTATE MEDICAL LICENSE