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NPI Code Detail

MEDICARE: STACEY T. NEAL M.D.

MEDICARE: STACEY T. NEAL M.D.
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
12084P0800XPsychiatry PhysicianD0060929MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
164758601OTHERMDMD RENDERING #
2550686OTHERMDVALUE OPTIONS PROVIDER #
3814276000OTHERMDMIS #
4T5140019OTHERMDCAREFIRST REGIONAL PAR#
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568476638
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY T. NEAL M.D.
Provider Business Mailing Address
First Line : 7141 SECURITY BLVD
Second Line :
City : BALTIMORE
State : MD
Zip : 21244-1811
Country : US
Telephone Number : 443-663-6485
Fax Number : 443-663-6026
Provider Business Practice Location Address
First Line : 7141 SECURITY BLVD
Second Line :
City : BALTIMORE
State : MD
Zip : 21244-1811
Country : US
Telephone Number : 443-663-6015
Fax Number : 443-663-6302
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 06/22/2021

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Directions to “ STACEY T. NEAL M.D.” Practice Location

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