MEDICARE: DR. MARK A. MACNEALY DO, JD

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	2084N0400X	Neurology Physician	34.002617	OH

General Provider Information

NPI Number	:	1861838922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A. MACNEALY DO, JD

Provider Business Mailing Address
First Line	:	9378 S MASON MONTGOMERY RD STE 102
Second Line	:
City	:	MASON
State	:	OH
Zip	:	45040-8827
Country	:	US
Telephone Number	:	937-809-9091
Fax Number	:	402-279-8571

Provider Business Practice Location Address
First Line	:	8859 CINCINNATI DAYTON RD STE 102
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-3193
Country	:	US
Telephone Number	:	513-880-8448
Fax Number	:	402-279-8571

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

Provider Enumeration Date	:	05/16/2013
Last Update Date	:	04/15/2025

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