Provider Demographics
NPI:1205216173
Name:NEALE, HENRY SR
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:NEALE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SHENANDOAH TERRACE
Mailing Address - Street 2:
Mailing Address - City:MONTREAT
Mailing Address - State:NC
Mailing Address - Zip Code:28757
Mailing Address - Country:US
Mailing Address - Phone:828-669-4471
Mailing Address - Fax:
Practice Address - Street 1:117 SHENANDOAH TERRACE
Practice Address - Street 2:
Practice Address - City:MONTREAT
Practice Address - State:NC
Practice Address - Zip Code:28757
Practice Address - Country:US
Practice Address - Phone:828-669-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94014602086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery