Provider Demographics
NPI:1225055858
Name:O'MALLEY, NEIL PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:PATRICK
Last Name:O'MALLEY
Suffix:
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:301-797-9240
Mailing Address - Fax:
Practice Address - Street 1:17 WESTERN MARYLAND PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5471
Practice Address - Country:US
Practice Address - Phone:301-797-9240
Practice Address - Fax:301-797-4234
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045409L207T00000X
MDD0050813207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDW2660002OtherBLUE SHIELD REGIONAL-MD
PA966244OtherPA BLUE SHIELD PA LOCATIO
140005758OtherRR MEDICARE
PAP00670421OtherRR MEDICARE
PA149523OtherPA BLUE SHIELD MD LOC
MD54359603OtherMD BLUE SHIELD
MD593901100Medicaid
MDG26980Medicare UPIN
PA966244OtherPA BLUE SHIELD PA LOCATIO
MD602L038DMedicare PIN