Provider Demographics
NPI:1942384433
Name:NEAL, JEFFREY GARDNER (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GARDNER
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:P.O. BOX 1328
Mailing Address - Street 2:ABINGDON EAR, NOSE & THROAT ASSOCIATES, P.C.
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:29403-6645
Mailing Address - Country:US
Mailing Address - Phone:276-628-9547
Mailing Address - Fax:276-628-8221
Practice Address - Street 1:176 VALLEY ST W
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2836
Practice Address - Country:US
Practice Address - Phone:276-628-9547
Practice Address - Fax:276-628-8221
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL25434207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA303202OtherANTHEM
VA1942384433Medicaid
VA1942384433Medicaid