Provider Demographics
NPI:1184689770
Name:MCNEILL, DIANNE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:MARIE
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 CEDAR LAKES DR STE 103
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8343
Mailing Address - Country:US
Mailing Address - Phone:757-410-9600
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236350208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010202175Medicaid
NC5904347Medicaid
VA010202175Medicaid
VA008824L76Medicare PIN