Provider Demographics
NPI:1023173655
Name:MACNEIL, MERL F (MD, PC)
Entity type:Individual
Prefix:
First Name:MERL
Middle Name:F
Last Name:MACNEIL
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 EAST ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WHITTINSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01588-1923
Mailing Address - Country:US
Mailing Address - Phone:508-234-9220
Mailing Address - Fax:508-234-7415
Practice Address - Street 1:103 EAST ST
Practice Address - Street 2:SUITE B
Practice Address - City:WHITTINSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01588-1923
Practice Address - Country:US
Practice Address - Phone:508-234-9220
Practice Address - Fax:508-234-7415
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA33566207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0160601Medicaid
MAA67989Medicare UPIN
MA0160601Medicaid