Healthcare Provider Details

I. General information

NPI: 1659959914
Provider Name (Legal Business Name): NEAL EDWARD BARTL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 ASHLEY AVE
CHARLESTON SC
29425-8905
US

IV. Provider business mailing address

1317 QUEEN LYON CT
CHARLOTTE NC
28205-5292
US

V. Phone/Fax

Practice location:
  • Phone: 704-677-4994
  • Fax:
Mailing address:
  • Phone: 704-677-4994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number303322
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: