MEDICARE: DR. MANUEL HIPOLITO ENRIQUEZ 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	207R00000X	Internal Medicine Physician	0101040783	VA
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	0101040783	VA
3	207RP1001X	Pulmonary Disease Physician	0101040783	VA

General Provider Information

NPI Number	:	1740252774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL HIPOLITO ENRIQUEZ M.D.

Provider Business Mailing Address
First Line	:	6439 GARNERS FERRY RD
Second Line	:	111E
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1638
Country	:	US
Telephone Number	:	803-776-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6439 GARNERS FERRY RD
Second Line	:	DVAMC (111)
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1638
Country	:	US
Telephone Number	:	803-776-4000
Fax Number	:

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	01/18/2016

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