Provider Demographics
NPI:1780177139
Name:NEAL, MALLORY LYNNE STEWART (DO)
Entity type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:LYNNE STEWART
Last Name:NEAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1088 LONDON LINKS DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4662
Mailing Address - Country:US
Mailing Address - Phone:434-534-6868
Mailing Address - Fax:
Practice Address - Street 1:1088 LONDON LINKS DR
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4662
Practice Address - Country:US
Practice Address - Phone:434-534-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102206454207Q00000X
VA0116031806390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI207Q00000XOtherFAMILY MEDICINE