Provider Demographics
NPI:1811968563
Name:O'NEAL, WILLIAM H (PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:O'NEAL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 JOHNSTON WILLIS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4730
Mailing Address - Country:US
Mailing Address - Phone:804-320-1333
Mailing Address - Fax:804-320-5606
Practice Address - Street 1:1471 JOHNSTON WILLIS DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4730
Practice Address - Country:US
Practice Address - Phone:804-320-1333
Practice Address - Fax:804-320-5606
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00703821OtherRR MEDICARE
VA1811968563Medicaid
VAQ47197Medicare UPIN
VA00X955F01Medicare PIN
VA1811968563Medicaid
VA007842V17Medicare PIN
P00787412Medicare PIN
VAP00703821OtherRR MEDICARE