Provider Demographics
NPI:1083969745
Name:DIANNE MCNEILL, MD, PLLC
Entity Type:Organization
Organization Name:DIANNE MCNEILL, MD, PLLC
Other - Org Name:CORNERSTONE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCNEILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-639-7798
Mailing Address - Street 1:802 FALLS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7295
Mailing Address - Country:US
Mailing Address - Phone:757-639-7798
Mailing Address - Fax:
Practice Address - Street 1:308 CEDAR LAKES DR STE 103
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-8343
Practice Address - Country:US
Practice Address - Phone:757-410-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010236350208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0102021750Medicaid
NC5904347Medicaid
I07343Medicare UPIN
008824L76Medicare PIN