=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548246341
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOUGLAS HUGH MCNEILL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2005
-----------------------------------------------------
Last Update Date | 07/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1721 TAUSSIG BOULEVARD BRANCH HEALTH CLINIC - NAVAL STATION NORFOLK
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23511-2298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-953-8760
-----------------------------------------------------
Fax | 757-953-8978
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1721 TAUSSIG BOULEVARD BRANCH HEALTH CLINIC - NAVAL STATION NORFOLK
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23511-2298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-953-8760
-----------------------------------------------------
Fax | 757-953-8978
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | N6550
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------