MEDICARE: CHRISTINE PAULETTE NEAL DO, MBS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207P00000X	Emergency Medicine Physician	20A24873	CA

General Provider Information

NPI Number	:	1407599004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE PAULETTE NEAL DO, MBS

Provider Business Mailing Address
First Line	:	4001 N 3RD ST STE 290
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2071
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 RIVERSIDE CIR
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24016-4961
Country	:	US
Telephone Number	:	800-422-8482
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2022
Last Update Date	:	04/02/2026

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