Provider Demographics
NPI:1881667319
Name:MCNEIL, PETER EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:EDWARD
Last Name:MCNEIL
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 1:240 S HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:MT CARMEL
Mailing Address - State:PA
Mailing Address - Zip Code:17851-2121
Mailing Address - Country:US
Mailing Address - Phone:570-339-1224
Mailing Address - Fax:570-339-1841
Practice Address - Street 1:240 S HICKORY ST
Practice Address - Street 2:
Practice Address - City:MT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-2121
Practice Address - Country:US
Practice Address - Phone:570-339-1224
Practice Address - Fax:570-339-1841
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025479E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01099296001Medicaid
PA01099296001Medicaid
PA114375Medicare PIN