MEDICARE: DR. MICHAEL S. MANETAS M.D.

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	174400000X	Specialist	0101231844	VA

General Provider Information

NPI Number	:	1275535213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL S. MANETAS M.D.

Provider Business Mailing Address
First Line	:	8220 MEADOWBRIDGE RD
Second Line	:	SUITE 311
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2336
Country	:	US
Telephone Number	:	804-559-6194
Fax Number	:	804-559-6197

Provider Business Practice Location Address
First Line	:	1010 N THOMPSON ST
Second Line	:	SUITE 200
City	:	RICHMOND
State	:	VA
Zip	:	23230-4911
Country	:	US
Telephone Number	:	804-358-1527
Fax Number	:	804-358-1520

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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