Provider Demographics
NPI:1619938685
Name:NEAL, GREEN B (MD)
Entity Type:Individual
Prefix:DR
First Name:GREEN
Middle Name:B
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 1:1415 BARNWELL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3511
Mailing Address - Country:US
Mailing Address - Phone:803-920-0953
Mailing Address - Fax:803-779-6623
Practice Address - Street 1:1415 BARNWELL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3511
Practice Address - Country:US
Practice Address - Phone:803-920-0953
Practice Address - Fax:803-779-6623
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9145207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00332709OtherMEDICARE RAILROAD
AA47180281OtherMEDICARE
SC091457Medicaid
AA47180281OtherMEDICARE
WI421841Medicare ID - Type Unspecified
SCP00332709OtherMEDICARE RAILROAD
WI421892Medicare ID - Type Unspecified
WI421832Medicare ID - Type Unspecified
SCAA4718Medicare PIN