Provider Demographics
NPI:1609284249
Name:NEAL, JEREMY J (PA-C)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:J
Last Name:NEAL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 620550
Mailing Address - Street 2:
Mailing Address - City:NEWTON LOWER FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02462-0550
Mailing Address - Country:US
Mailing Address - Phone:781-867-2050
Mailing Address - Fax:781-867-2040
Practice Address - Street 1:45 DAN RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2852
Practice Address - Country:US
Practice Address - Phone:781-867-2050
Practice Address - Fax:781-867-2040
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT055-0031209363AM0700X
NH1469363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical