Healthcare Provider Details

I. General information

NPI: 1053373654
Provider Name (Legal Business Name): DEMAR AUSTIN NEAL M.D., F.A.C.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 COURT DR SUITE 450
GASTONIA NC
28054-2134
US

IV. Provider business mailing address

2555 COURT DR SUITE 450
GASTONIA NC
28054-2134
US

V. Phone/Fax

Practice location:
  • Phone: 704-671-7652
  • Fax: 704-671-7656
Mailing address:
  • Phone: 704-671-7652
  • Fax: 704-671-7656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number27265
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: