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General NPI Number Information
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NPI Number | 1821289174
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Entity Type | Individual
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Provider Name | JOHN MICHAEL NEIDECKER DO
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Gender | Male
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 11200 GOVERNOR MANLY WAY STE 309
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City | RALEIGH
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State | NC
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Zip | 27614-7375
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Country | US
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Telephone | 919-562-9410
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Fax | 919-562-2948
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Provider Business Mailing Address
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Address Line | PO BOX 1107
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City | WAKE FOREST
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State | NC
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Zip | 27588-1107
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Country | US
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Telephone | 919-562-9410
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Fax | 919-562-2948
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 207Q00000X
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License Number State | NJ
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