Provider Demographics
NPI:1558438663
Name:MCMANUS, REGINALD P (MD)
Entity Type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:P
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 1:5300 JUXON PLACE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151
Mailing Address - Country:US
Mailing Address - Phone:703-331-7156
Mailing Address - Fax:703-525-0084
Practice Address - Street 1:2525 N 10TH ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201
Practice Address - Country:US
Practice Address - Phone:703-525-7040
Practice Address - Fax:703-525-0084
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101014849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C62198Medicare UPIN
VA169503Medicare PIN