Healthcare Provider Details

I. General information

NPI: 1801380464
Provider Name (Legal Business Name): THOMAS WILLIAM NEAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 MEMORIAL AVE STE 10
LYNCHBURG VA
24501-2652
US

IV. Provider business mailing address

2323 MEMORIAL AVE STE 10
LYNCHBURG VA
24501-2652
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5200
  • Fax:
Mailing address:
  • Phone: 434-200-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116031802
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101269569
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: