Provider Demographics
NPI:1477949840
Name:NEIL, ANASTASIA MARIE (DO)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:MARIE
Last Name:NEIL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:MARIE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1673 ROUTE 65
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-5217
Mailing Address - Country:US
Mailing Address - Phone:724-758-7559
Mailing Address - Fax:724-758-7560
Practice Address - Street 1:1673 ROUTE 65
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-5217
Practice Address - Country:US
Practice Address - Phone:724-758-7559
Practice Address - Fax:724-758-7560
Is Sole Proprietor?:No
Enumeration Date:2015-04-12
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018468207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103245770Medicaid