Basic Information
| Provider Information | |||||||||
| NPI: | 1750574471 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANCHENO | ||||||||
| FirstName: | RODRIGO | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2546 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234502546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573403489 | ||||||||
| FaxNumber: | 7573404278 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 NORTHSIDE CHEROKEE BLVD | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301158015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702241000 | ||||||||
| FaxNumber: | 7702242451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2007 | ||||||||
| LastUpdateDate: | 03/07/2018 | ||||||||
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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 | 208M00000X | 071387 | GA | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 0101251149 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MT189804 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD440345 | PA | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.