Provider Demographics
NPI:1811919137
Name:NEELY, EILEEN P (MD)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:P
Last Name:NEELY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:935 THORN RUN RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2861
Mailing Address - Country:US
Mailing Address - Phone:412-299-8400
Mailing Address - Fax:412-299-8497
Practice Address - Street 1:935 THORN RUN RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2861
Practice Address - Country:US
Practice Address - Phone:412-299-7400
Practice Address - Fax:412-299-8497
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2010-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD043496E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011877820013Medicaid
PA424402Medicare ID - Type Unspecified
PA0011877820013Medicaid