Provider Demographics
NPI:1326207952
Name:JOYCE W NEAL MD PC
Entity Type:Organization
Organization Name:JOYCE W NEAL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:NORRIS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-769-2656
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:LOVEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20656-0160
Mailing Address - Country:US
Mailing Address - Phone:301-475-0145
Mailing Address - Fax:301-475-0443
Practice Address - Street 1:23140 MOAKLEY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2930
Practice Address - Country:US
Practice Address - Phone:301-475-0145
Practice Address - Fax:301-475-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050618174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD893103800Medicaid
MD707MMedicare PIN