Basic Information
| Provider Information | |||||||||
| NPI: | 1174798599 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEAL | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | CATHERINE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 E MCBEE AVE FL 1 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296012842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645228603 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 MEDICAL RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296054267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642207270 | ||||||||
| FaxNumber: | 8642419211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2008 | ||||||||
| LastUpdateDate: | 06/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2012-00086 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | E-6841 | AR | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 38136 | SC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1174798599 | 05 | NC | MEDICAID | 381367 | 05 | SC | MEDICAID | 5920785 | 05 | NC | MEDICAID |