Provider Demographics
NPI:1669405171
Name:BROCKINGTON, MCNEAL (MD)
Entity type:Individual
Prefix:
First Name:MCNEAL
Middle Name:
Last Name:BROCKINGTON
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 1:6 STOCKMILL RD
Mailing Address - Street 2:APT 1
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2558
Mailing Address - Country:US
Mailing Address - Phone:410-655-9509
Mailing Address - Fax:
Practice Address - Street 1:4 W ROLLING CROSSROADS
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-6280
Practice Address - Country:US
Practice Address - Phone:410-869-0100
Practice Address - Fax:470-869-0460
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0032904207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0084OtherCAREFIRST DC
2136469OtherMAMSI
5226116OtherAETNA PPO
7064270010OtherCIGNA
213090OtherKAISER
MD35042306OtherCAREFIRST MARYLAND
2570547OtherAETNA HMO
MD04492Medicaid
2570547OtherAETNA HMO