Healthcare Provider Details

I. General information

NPI: 1326257643
Provider Name (Legal Business Name): CLIFTON L NEAL JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 ARBOR DRIVE SUITE 111 MARKET PLACE
CHRISTIANSBURG VA
24073
US

IV. Provider business mailing address

PO BOX 6115
BLUEFIELD WV
24701-6115
US

V. Phone/Fax

Practice location:
  • Phone: 800-937-6327
  • Fax: 304-324-8308
Mailing address:
  • Phone: 304-324-8358
  • Fax: 304-324-8308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1625
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: