Basic Information
| Provider Information | |||||||||
| NPI: | 1114925500 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCKENZIE | ||||||||
| FirstName: | CHAD | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5818 HARBOUR VIEW BLVD | ||||||||
| Address2: | STE 240 | ||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573972383 | ||||||||
| FaxNumber: | 7573975201 | ||||||||
| Practice Location | |||||||||
| Address1: | 5818 HARBOUR VIEW BLVD | ||||||||
| Address2: | STE 240 | ||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573972383 | ||||||||
| FaxNumber: | 7573975201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2005 | ||||||||
| LastUpdateDate: | 01/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 0102201282 | VA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 89065C3 | 01 | NC | MEDICAID OF N.C. | OTHER | 276458 | 01 | VA | ANTHEM | OTHER | 51895 | 01 | VA | OPTIMA | OTHER | 007312393 | 05 | VA | MEDICAID | 770003026 | 01 | VA | MEDICARE RAILROAD | OTHER |