Provider Demographics
NPI:1477563229
Name:MCMANUS, KEITH ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ERIC
Last Name:MCMANUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:269 GILLMAN RD STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-7923
Practice Address - Country:US
Practice Address - Phone:704-316-4930
Practice Address - Fax:704-316-4931
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32789207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC56872OtherBCBS OF NC
NC8957844Medicaid
NC56872OtherBCBS OF NC
NCC86945Medicare UPIN