Provider Demographics
NPI:1689793515
Name:MCNEILL, ELAINA HAYWOOD (PT)
Entity Type:Individual
Prefix:
First Name:ELAINA
Middle Name:HAYWOOD
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 HOLLADAY PARK RD
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1119
Mailing Address - Country:US
Mailing Address - Phone:410-987-1432
Mailing Address - Fax:
Practice Address - Street 1:888 BESTGATE RD
Practice Address - Street 2:SUITE 316
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3091
Practice Address - Country:US
Practice Address - Phone:410-266-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD162622251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD865M623FMedicare PIN