Provider Demographics
NPI:1114965159
Name:MANKE, CHAD R (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:R
Last Name:MANKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:230 CLEARFIELD AVE
Mailing Address - Street 2:STE 124
Mailing Address - City:VA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462
Mailing Address - Country:US
Mailing Address - Phone:757-321-3383
Mailing Address - Fax:757-321-3332
Practice Address - Street 1:1975 GLENN MITCHELL DR
Practice Address - Street 2:STE 200
Practice Address - City:VA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0167
Practice Address - Country:US
Practice Address - Phone:757-321-3383
Practice Address - Fax:757-321-3332
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101102721207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010064279Medicaid
VA004436V01OtherMEDICARE PTAN
VA004436V01OtherMEDICARE PTAN
I05721Medicare UPIN