Healthcare Provider Details

I. General information

NPI: 1083969745
Provider Name (Legal Business Name): DIANNE MCNEILL, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 CEDAR LAKES DR STE 103
CHESAPEAKE VA
23322-8343
US

IV. Provider business mailing address

802 FALLS CREEK DR
CHESAPEAKE VA
23322-7295
US

V. Phone/Fax

Practice location:
  • Phone: 757-410-9600
  • Fax:
Mailing address:
  • Phone: 757-639-7798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number010236350
License Number StateVA

VIII. Authorized Official

Name: DR. DIANNE MARIE MCNEILL
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 757-639-7798