Provider Demographics
NPI:1407327901
Name:MADDOX-MCNEIL, ELISE A (TRICHOLOGIST)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:A
Last Name:MADDOX-MCNEIL
Suffix:
Gender:F
Credentials:TRICHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 POST OAK DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2787
Mailing Address - Country:US
Mailing Address - Phone:301-833-1952
Mailing Address - Fax:
Practice Address - Street 1:1513 POST OAK DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2787
Practice Address - Country:US
Practice Address - Phone:301-883-1952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-09
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management