MEDICARE: DR. CHAD M MCKENZIE D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	0102201282	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	770003026	OTHER	VA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	276458	OTHER	VA	ANTHEM
3	51895	OTHER	VA	OPTIMA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114925500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD M MCKENZIE D.O.

Provider Business Mailing Address
First Line	:	5818 HARBOUR VIEW BLVD
Second Line	:	STE 240
City	:	SUFFOLK
State	:	VA
Zip	:	23435
Country	:	US
Telephone Number	:	757-397-2383
Fax Number	:	757-397-5201

Provider Business Practice Location Address
First Line	:	5818 HARBOUR VIEW BLVD
Second Line	:	STE 240
City	:	SUFFOLK
State	:	VA
Zip	:	23435
Country	:	US
Telephone Number	:	757-397-2383
Fax Number	:	757-397-5201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	01/15/2018

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Directions to “ DR. CHAD M MCKENZIE D.O.” Practice Location

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