Basic Information
| Provider Information | |||||||||
| NPI: | 1760474217 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEAL | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | RONALD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 802 GREEN VALLEY RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362733661 | ||||||||
| FaxNumber: | 3362739438 | ||||||||
| Practice Location | |||||||||
| Address1: | 802 GREEN VALLEY RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362733661 | ||||||||
| FaxNumber: | 3362739438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2005 | ||||||||
| LastUpdateDate: | 08/15/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 19764 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 89-61966 | 05 | NC | MEDICAID |