Provider Demographics
NPI:1417954025
Name:NEAL, WALTER JR (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:NEAL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3011
Mailing Address - Country:US
Mailing Address - Phone:910-272-3051
Mailing Address - Fax:
Practice Address - Street 1:725 OAKRIDGE BLVD
Practice Address - Street 2:STE C-1
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2375
Practice Address - Country:US
Practice Address - Phone:910-608-3078
Practice Address - Fax:910-608-3079
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18128207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8961924Medicaid
C85711Medicare UPIN
NC8961924Medicaid