Healthcare Provider Details

I. General information

NPI: 1881629590
Provider Name (Legal Business Name): KENNETH W NEAL JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 S CARLIN SPRINGS RD SUITE 406
ARLINGTON VA
22204-1064
US

IV. Provider business mailing address

611 S CARLIN SPRINGS RD SUITE 406
ARLINGTON VA
22204-1064
US

V. Phone/Fax

Practice location:
  • Phone: 571-431-6175
  • Fax: 571-431-6179
Mailing address:
  • Phone: 571-431-6175
  • Fax: 571-431-6179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number0101237321
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101237321
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number0101237321
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: