Provider Demographics
NPI:1841213683
Name:MCNEELY, HENRY E (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:E
Last Name:MCNEELY
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 1:3637 MISSION AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2946
Mailing Address - Country:US
Mailing Address - Phone:916-863-1496
Mailing Address - Fax:916-863-1498
Practice Address - Street 1:3637 MISSION AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-2946
Practice Address - Country:US
Practice Address - Phone:916-863-1496
Practice Address - Fax:916-863-1498
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF17286174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G547200Medicaid
CA00G547200Medicaid
CAF17286Medicare ID - Type Unspecified