Healthcare Provider Details

I. General information

NPI: 1184654584
Provider Name (Legal Business Name): JOHN LEACH MACNEILL JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/27/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 THOMSON DR SUITE 200
LYNCHBURG VA
24501-1118
US

IV. Provider business mailing address

1701 THOMSON DR SUITE 200
LYNCHBURG VA
24501-1118
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5925
  • Fax: 434-200-5929
Mailing address:
  • Phone: 434-200-5925
  • Fax: 434-200-5929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101043732
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number0101043732
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: