=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245009760
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUASAR INTERNAL MEDICINE NORTH CAROLINA PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2023
-----------------------------------------------------
Last Update Date | 12/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221A PROFESSIONAL CIR
-----------------------------------------------------
City | MOREHEAD CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28557-4303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-308-4746
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4850 TAMIAMI TRL N UNIT 301
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34103-3034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-308-4746
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SEAN ALEXANDER FEINBERG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 239-544-0647
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------