Individual
KEITH P MANKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4301 LAKE BOONE TRL, STE 205, RALEIGH, NC 27607-7507
(919) 977-0427
(919) 977-0896
Mailing address
4301 LAKE BOONE TRL, STE. 205, RALEIGH, NC 27607-7507
(919) 977-0427
(919) 977-0896
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
200001509
NC
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
200001509
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275V
BCBS
NC
05
—
891275V
—
NC
Enumeration date
05/24/2005
Last updated
11/22/2014
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