Basic Information
| Provider Information | |||||||||
| NPI: | 1629106356 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEEL | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4822 SIX FORKS RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276095269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193364244 | ||||||||
| FaxNumber: | 9198913681 | ||||||||
| Practice Location | |||||||||
| Address1: | 4822 SIX FORKS RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276095269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193364244 | ||||||||
| FaxNumber: | 9198913681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 12/10/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 200000564 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 208000000X | 200000564 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 200000564 | 01 | NC | MEDICAL LICENSE | OTHER |