=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700082203
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PETER E MCNEIL MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 240 S HICKORY ST
-----------------------------------------------------
City | MOUNT CARMEL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17851-2121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-339-1224
-----------------------------------------------------
Fax | 570-339-1841
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 240 S HICKORY ST
-----------------------------------------------------
City | MOUNT CARMEL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17851-2121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-339-1224
-----------------------------------------------------
Fax | 570-339-1841
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | PETER MCNEIL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 570-339-1224
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD025479E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------