Provider Demographics
NPI:1114925500
Name:MCKENZIE, CHAD M (DO)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:M
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5818 HARBOUR VIEW BLVD
Mailing Address - Street 2:STE 240
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435
Mailing Address - Country:US
Mailing Address - Phone:757-397-2383
Mailing Address - Fax:757-397-5201
Practice Address - Street 1:5818 HARBOUR VIEW BLVD
Practice Address - Street 2:STE 240
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435
Practice Address - Country:US
Practice Address - Phone:757-397-2383
Practice Address - Fax:757-397-5201
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022012822086S0129X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89065C3OtherMEDICAID OF N.C.
VA276458OtherANTHEM
VA51895OtherOPTIMA
VA007312393Medicaid
VA770003026OtherMEDICARE RAILROAD
VA007312393Medicaid
NC89065C3OtherMEDICAID OF N.C.