Provider Demographics
NPI:1386690097
Name:NEAL, CLIFFORD JAMES (DO)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:JAMES
Last Name:NEAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 HOWARD AVE
Mailing Address - Street 2:ALTOONA REGIONAL HEALTH SYSTEM
Mailing Address - City:ALTOON
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4899
Mailing Address - Country:US
Mailing Address - Phone:814-889-2866
Mailing Address - Fax:814-889-6785
Practice Address - Street 1:620 HOWARD AVE
Practice Address - Street 2:ALTOONA REGIONAL HEALTH SYSTEM DEPT OF EMERGENCY MEDICI
Practice Address - City:ALTOON
Practice Address - State:PA
Practice Address - Zip Code:16601-4899
Practice Address - Country:US
Practice Address - Phone:814-889-2866
Practice Address - Fax:814-889-6785
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS007295E207P00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E906202Medicare UPIN
661196JNYMedicare ID - Type Unspecified