Provider Demographics
NPI:1558360735
Name:MCMANUS, PATRICK J (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:MCMANUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3311
Mailing Address - Country:US
Mailing Address - Phone:540-370-1940
Mailing Address - Fax:540-370-4246
Practice Address - Street 1:2501 CHARLES ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3311
Practice Address - Country:US
Practice Address - Phone:540-370-1940
Practice Address - Fax:540-370-4246
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2017-08-11
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
VA0101042027207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005828481Medicaid
VA005828481Medicaid
VA110007446Medicare ID - Type Unspecified