Individual
CHARLES MANETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14107 MORTEMER RD, MIDLOTHIAN, VA 23113-6060
(804) 378-7797
Mailing address
14107 MORTEMER RD, MIDLOTHIAN, VA 23113-6060
(804) 378-7797
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101021604
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7207760
—
VA
Enumeration date
05/28/2014
Last updated
05/28/2014
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