Provider Demographics
NPI:1083616882
Name:MCNEAL, ALVAN SCOTT (DO)
Entity Type:Individual
Prefix:DR
First Name:ALVAN
Middle Name:SCOTT
Last Name:MCNEAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1412 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2908
Mailing Address - Country:US
Mailing Address - Phone:215-235-9600
Mailing Address - Fax:215-232-4093
Practice Address - Street 1:1412 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2908
Practice Address - Country:US
Practice Address - Phone:215-235-9600
Practice Address - Fax:215-232-4093
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 006886 L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA609582OtherHIGHMARK
PA0432388000OtherINDEPENDENCE BLUE CROSS
PA001247174Medicaid
PA80169797OtherRR MEDICARE
PA0124717408OtherAMERICHOICE
PA11494OtherBRAVO ELDER HEALTH
PA13361OtherHEALTH PARTNERS
PA30009751OtherKEYSTONE MERCY
PA609582D9NMedicare PIN
PA30009751OtherKEYSTONE MERCY