Healthcare Provider Details

I. General information

NPI: 1265417406
Provider Name (Legal Business Name): NEAL H CARL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 GASKINS ROAD SUITE A
RICHMOND VA
23238
US

IV. Provider business mailing address

2500 GASKINS ROAD SUITE A
RICHMOND VA
23238
US

V. Phone/Fax

Practice location:
  • Phone: 804-774-7099
  • Fax: 888-908-6676
Mailing address:
  • Phone: 804-774-7099
  • Fax: 888-908-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101102633
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: