Provider Demographics
NPI:1437111960
Name:MCNEILL, PAUL MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MATTHEW
Last Name:MCNEILL
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 1:77 THOMAS JOHNSON DR STE E
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4893
Mailing Address - Country:US
Mailing Address - Phone:301-695-8346
Mailing Address - Fax:301-624-5837
Practice Address - Street 1:77 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE E
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4893
Practice Address - Country:US
Practice Address - Phone:301-695-8346
Practice Address - Fax:301-668-7819
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00458922086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD867L215EMedicare ID - Type Unspecified
F81199Medicare UPIN