Individual provider Active NPI

Mallory Lynne Stewart Neal, DO

  • Family Medicine Physician
  • Forest, VA
National Provider Identifier
1780177139
Registry record updated Oct 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0102206454 Issued in VA
Practice address
1088 London Links Dr
Forest, VA 24551-4662
Phone
(434) 534-6868
NPI assigned
Jun 11, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0102206454 VA Primary

Addresses

Primary practice location

1088 London Links Dr
Forest, VA 24551-4662

Mailing address

1088 London Links Dr
Forest, VA 24551-4662
Phone (434) 534-6868

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211008000120 VA Practitioner - Family Practice 5395095590 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Edward Via Col of Osteo Medicine-Virginia Campus, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Privia Medical Group, LLCGroup PAC ID 4385682061, 1,522 clinicians

Practice addresses (Care Compare)

527 Pocket Rd
Hurt, VA 24563-2023
Phone (434) 324-9150

8644 Sudley Rd
Suite 220
Manassas, VA 20110-4425
Phone (571) 366-8845

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
0102206454VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC CurrentSince Sep 2, 2021 Accepting new patients
Privia Medical Group, LLC Family Medicine CurrentSince Sep 2, 2021 Accepting new patients
Nova Physician Wellness Center PLLC Family Medicine Past Accepting new patients

Locations

950 N Glebe Rd
Ste 700
Arlington, VA 22203
Phone (484) 228-1065

1088 London Links Dr
Forest, VA 24551
Phone (434) 534-6868

205 Archway Ct
Lynchburg, VA 24502

8644 Sudley Rd
#220
Manassas, VA 20110

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
  • Direct secure messaging: mallory.stewart.1@8042.direct.athenahealth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698278400000",
    "number": "1780177139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1088 LONDON LINKS DR",
            "city": "FOREST",
            "state": "VA",
            "postal_code": "245514662",
            "telephone_number": "434-534-6868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1088 LONDON LINKS DR",
            "city": "FOREST",
            "state": "VA",
            "postal_code": "245514662",
            "telephone_number": "434-534-6868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEAL",
        "first_name": "MALLORY",
        "middle_name": "LYNNE STEWART",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-11",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0102206454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest, VA

Sources for this page

Verify at the official NPI Registry.