Provider Demographics
NPI:1932212982
Name:MANOLIO, RICHARD L (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:MANOLIO
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:PO BOX 1774
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23327-1774
Mailing Address - Country:US
Mailing Address - Phone:757-490-9388
Mailing Address - Fax:757-490-9401
Practice Address - Street 1:736 BATTLEFIELD BLVD N
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4941
Practice Address - Country:US
Practice Address - Phone:757-312-6200
Practice Address - Fax:757-312-6181
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047528207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
082480OtherBLUE CROSS BLUE SHIELD VA
251490OtherMAMSI/MDIPA
3900570OtherOPTIMUM CHOICE
930041250OtherMEDICARE RAILROAD
VA6006621Medicaid
VA930041250OtherRR MEDICARE
NC890594YMedicaid
0594YOtherBLUE CROSS BLUE SHIELD NC
15889OtherOPTIMA
3900570OtherOPTIMUM CHOICE