Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 38200 | SC |
N | 208000000X | Pediatrician | 2012-00845 | NC |
N | 208000000X | Pediatrician | 38200 | SC |
NPI | 1740414002 |
---|---|
Provider Name | Dr. Matthew Bradley Neal |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29605-4210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2009 |
Last Update Date | 08/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1740414002 | (05) | NC |
NC1638 | (05) | SC |