Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 0102201282 | VA |
NPI | 1114925500 |
---|---|
Provider Name | Dr. Chad M Mckenzie |
First Address | Suffolk, VA 23435 |
Second Address | Suffolk, VA 23435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 15/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007312393 | (05) | VA |
276458 | ANTHEM (01) | VA |
51895 | OPTIMA (01) | VA |
770003026 | MEDICARE RAILROAD (01) | VA |
89065C3 | MEDICAID OF N.C. (01) | NC |
H59017 | (02) | VA |