Provider Demographics
NPI:1841217932
Name:ONEIL, SCOTT MARK (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:MARK
Last Name:ONEIL
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 1:319 HOSPITAL DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1929
Mailing Address - Country:US
Mailing Address - Phone:276-656-2103
Mailing Address - Fax:276-656-2105
Practice Address - Street 1:319 HOSPITAL DR
Practice Address - Street 2:SUITE 208
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1929
Practice Address - Country:US
Practice Address - Phone:276-656-2103
Practice Address - Fax:276-656-2105
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057668174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG71344Medicare UPIN