Healthcare Provider Details

I. General information

NPI: 1205369915
Provider Name (Legal Business Name): BERLONDRIKA JERTORIA MCNEAL M.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10208 CERNY ST STE 210
RALEIGH NC
27617-7885
US

IV. Provider business mailing address

10208 CERNY ST STE 210
RALEIGH NC
27617-7885
US

V. Phone/Fax

Practice location:
  • Phone: 919-484-8345
  • Fax: 919-484-8218
Mailing address:
  • Phone: 919-484-8345
  • Fax: 919-484-8218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number202004062
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: