Provider Demographics
NPI:1255380317
Name:NEAL, MARIANNE R (MD)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:R
Last Name:NEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1301 SUNSET DR
Mailing Address - Street 2:STE 3
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-7906
Mailing Address - Country:US
Mailing Address - Phone:423-926-4966
Mailing Address - Fax:423-926-1823
Practice Address - Street 1:1301 SUNSET DR
Practice Address - Street 2:STE 3
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-7906
Practice Address - Country:US
Practice Address - Phone:423-926-4966
Practice Address - Fax:423-926-1823
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN313652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89063JKOtherNORTH CAROLINA MEDICAID
TN3130527OtherBCBS
KY64018062OtherKENTUCKY MEDICAID
VA7222084OtherVIRGINIA MEDICAID
TN3840962Medicaid
VA7222084OtherVIRGINIA MEDICAID
TN3840962Medicaid