Provider Demographics
NPI:1518028257
Name:MCNEELY, MARSHA C (MD PHD)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:C
Last Name:MCNEELY
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5454 WISCONSIN AVE
Mailing Address - Street 2:SUITE 1045
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6901
Mailing Address - Country:US
Mailing Address - Phone:301-652-4828
Mailing Address - Fax:301-652-2070
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:SUITE 1045
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6901
Practice Address - Country:US
Practice Address - Phone:301-652-4828
Practice Address - Fax:301-652-2070
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD000017939207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC30110001OtherCAREFIRST BC/BS
070010761OtherRAILROAD MEDICARE
C62419Medicare UPIN
DC30110001OtherCAREFIRST BC/BS