Provider Demographics
NPI:1053522268
Name:MCNEIL, CARRIE L (MD)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0304
Mailing Address - Country:US
Mailing Address - Phone:518-854-3821
Mailing Address - Fax:518-854-3224
Practice Address - Street 1:213 MAIN STREET
Practice Address - Street 2:SALEM FAMILY HEALTH CENTER
Practice Address - City:SALEM
Practice Address - State:NY
Practice Address - Zip Code:12865
Practice Address - Country:US
Practice Address - Phone:518-854-3821
Practice Address - Fax:518-854-3224
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY256572207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03251989Medicaid