Provider Demographics
NPI:1124092465
Name:MCNEILL, STEPHEN MARK (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MARK
Last Name:MCNEILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 701
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0701
Mailing Address - Country:US
Mailing Address - Phone:828-587-6311
Mailing Address - Fax:828-586-8209
Practice Address - Street 1:3 DOCTORS PARK STE A
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4521
Practice Address - Country:US
Practice Address - Phone:828-772-8673
Practice Address - Fax:828-586-8209
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200400149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200400149OtherNC MEDICAL BOARD LICENSE
NCP00345715OtherRR MEDICARE
NC11541767OtherCAQH
NC5903489Medicaid
NC142W1OtherBCBS NC
NC142W1OtherBCBS NC