Provider Demographics
NPI:1073517595
Name:MCNEIL, EDWARD J JR (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:MCNEIL
Suffix:JR
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 1:109 SPANISH POINT DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-6130
Mailing Address - Country:US
Mailing Address - Phone:843-812-2838
Mailing Address - Fax:
Practice Address - Street 1:109 SPANISH POINT DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-6130
Practice Address - Country:US
Practice Address - Phone:843-812-2838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1566Medicaid
57-1060903OtherTAX ID
SCC604588580Medicare PIN
SCC60458Medicare UPIN
SCGP1566Medicaid