1962466516 NPI number — COLIN MACNEILL MD

Table of content: COLIN MACNEILL MD (NPI 1962466516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962466516 NPI number — COLIN MACNEILL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACNEILL
Provider First Name:
COLIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962466516
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 854
Provider Second Line Business Mailing Address:
MC A410
Provider Business Mailing Address City Name:
HERSHEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17033-0854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-233-4082
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
670 CHERRY DR
Provider Second Line Business Practice Location Address:
STE 202/204
Provider Business Practice Location Address City Name:
HERSHEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17033-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-233-4082
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  MD042457L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0012915570007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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