Basic Information
| Provider Information | |||||||||
| NPI: | 1083616882 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCNEAL | ||||||||
| FirstName: | ALVAN | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1412 FAIRMOUNT AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191302908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152359600 | ||||||||
| FaxNumber: | 2152324093 | ||||||||
| Practice Location | |||||||||
| Address1: | 1412 FAIRMOUNT AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191302908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152359600 | ||||||||
| FaxNumber: | 2152324093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 08/14/2015 | ||||||||
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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 | 207Q00000X | OS 006886 L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 609582 | 01 | PA | HIGHMARK | OTHER | 0432388000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 001247174 | 05 | PA | MEDICAID | 80169797 | 01 | PA | RR MEDICARE | OTHER | 0124717408 | 01 | PA | AMERICHOICE | OTHER | 11494 | 01 | PA | BRAVO ELDER HEALTH | OTHER | 13361 | 01 | PA | HEALTH PARTNERS | OTHER | 30009751 | 01 | PA | KEYSTONE MERCY | OTHER |