Healthcare Provider Details

I. General information

NPI: 1740290824
Provider Name (Legal Business Name): GEORGE B NEAL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CONSTITUTION DRIVE UNIT 6
BEDFORD NH
03110
US

IV. Provider business mailing address

18 CONSTITUTION DRIVE UNIT 6
BEDFORD NH
03110
US

V. Phone/Fax

Practice location:
  • Phone: 603-472-8624
  • Fax: 603-472-9146
Mailing address:
  • Phone: 603-472-8624
  • Fax: 603-472-9146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number6956
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number6956
License Number StateNH

VIII. Authorized Official

Name: GEORGE B NEAL
Title or Position: PRESIDENT
Credential: MD
Phone: 603-472-8624