Provider Demographics
NPI:1053380683
Name:NEAL, CHARLES W (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:NEAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:17952 RESCUE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:IL
Mailing Address - Zip Code:62836-1001
Mailing Address - Country:US
Mailing Address - Phone:618-629-2121
Mailing Address - Fax:
Practice Address - Street 1:4117 S WATER TOWER PL
Practice Address - Street 2:SUITE D
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6293
Practice Address - Country:US
Practice Address - Phone:618-242-4848
Practice Address - Fax:618-242-4198
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E64514Medicare UPIN
209237Medicare ID - Type Unspecified