Provider Demographics
NPI:1578626826
Name:NEAL, RANDOLPH V (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:V
Last Name:NEAL
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 1:101 HOLBROOK ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1732
Mailing Address - Country:US
Mailing Address - Phone:434-685-7952
Mailing Address - Fax:
Practice Address - Street 1:101 HOLBROOK ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1732
Practice Address - Country:US
Practice Address - Phone:434-792-7765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055662174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010019613Medicaid
VA00V775030Medicare ID - Type Unspecified