Provider Demographics
NPI:1821089822
Name:NEAL, NORMAN GLEN (MD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:GLEN
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 1:1525 DICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-2168
Mailing Address - Country:US
Mailing Address - Phone:504-818-0006
Mailing Address - Fax:505-818-0095
Practice Address - Street 1:1525 DICKORY AVE
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-2168
Practice Address - Country:US
Practice Address - Phone:504-818-0006
Practice Address - Fax:505-818-0095
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15167R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00740059OtherRAILROAD
LAP00392494OtherRRM
LA1582808Medicaid
LAP00740059OtherRAILROAD
4F878Medicare ID - Type Unspecified
LA1582808Medicaid
LA4F878DE56Medicare PIN