Provider Demographics
NPI:1750451282
Name:MACKINNON, RODERICK R (MD)
Entity Type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:R
Last Name:MACKINNON
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:4041 TAYLOR RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5536
Mailing Address - Country:US
Mailing Address - Phone:757-484-5828
Mailing Address - Fax:757-484-4371
Practice Address - Street 1:4041 TAYLOR RD
Practice Address - Street 2:SUITE G
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5536
Practice Address - Country:US
Practice Address - Phone:757-484-5828
Practice Address - Fax:757-484-4371
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101035767207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV0227AMedicare PIN
B05078Medicare UPIN