Provider Demographics
NPI:1265423941
Name:FEAGINS, STEPHEN R (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:FEAGINS
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 1:8000 5 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-2187
Mailing Address - Country:US
Mailing Address - Phone:513-233-6980
Mailing Address - Fax:513-233-6983
Practice Address - Street 1:8000 5 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2187
Practice Address - Country:US
Practice Address - Phone:513-233-6980
Practice Address - Fax:513-233-6983
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071290207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2233005Medicaid
2559361OtherAETNA
OH110225800OtherRR MEDICARE
OH000000195864OtherANTHEM
0401897OtherUNITED HEALTHCARE OF OHIO
FE4045011Medicare PIN