1932212982 NPI number — RICHARD L MANOLIO M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932212982 NPI number — RICHARD L MANOLIO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANOLIO
Provider First Name:
RICHARD
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932212982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1774
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23327-1774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-490-9388
Provider Business Mailing Address Fax Number:
757-490-9401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
736 BATTLEFIELD BLVD N
Provider Second Line Business Practice Location Address:
EMERGENCY DEPARTMENT
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320-4941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-312-6200
Provider Business Practice Location Address Fax Number:
757-312-6181
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X , with the licence number:  0101047528 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 0101047528 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 082480 . This is a "BLUE CROSS BLUE SHIELD VA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 251490 . This is a "MAMSI/MDIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3900570 . This is a "OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 930041250 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6006621 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 930041250 . This is a "RR MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 890594Y , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0594Y . This is a "BLUE CROSS BLUE SHIELD NC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15889 . This is a "OPTIMA" identifier . This identifiers is of the category "OTHER".




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