Provider Demographics
NPI:1184654584
Name:MACNEILL, JOHN LEACH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEACH
Last Name:MACNEILL
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 1:1701 THOMSON DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1118
Mailing Address - Country:US
Mailing Address - Phone:434-200-5925
Mailing Address - Fax:434-200-5929
Practice Address - Street 1:1701 THOMSON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1118
Practice Address - Country:US
Practice Address - Phone:434-200-5925
Practice Address - Fax:434-200-5929
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043732174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006024866Medicaid
VAE61226Medicare UPIN
VA006024866Medicaid
VA110002592Medicare ID - Type Unspecified