Provider Demographics
NPI:1881629590
Name:NEAL, KENNETH W JR (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:NEAL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:611 S CARLIN SPRINGS RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1064
Mailing Address - Country:US
Mailing Address - Phone:571-431-6175
Mailing Address - Fax:571-431-6179
Practice Address - Street 1:611 S CARLIN SPRINGS RD
Practice Address - Street 2:SUITE 406
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1064
Practice Address - Country:US
Practice Address - Phone:571-431-6175
Practice Address - Fax:571-431-6179
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101237321207ND0101X, 207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAI12579Medicare UPIN