Provider Demographics
NPI:1528061348
Name:MANKIN, KEITH P (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:P
Last Name:MANKIN
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 1:4301 LAKE BOONE TRL
Mailing Address - Street 2:STE. 205
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7507
Mailing Address - Country:US
Mailing Address - Phone:919-977-0427
Mailing Address - Fax:919-977-0896
Practice Address - Street 1:4301 LAKE BOONE TRL
Practice Address - Street 2:STE 205
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7507
Practice Address - Country:US
Practice Address - Phone:919-977-0427
Practice Address - Fax:919-977-0896
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2014-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001509207X00000X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891275VMedicaid
NC1275VOtherBCBS
NC891275VMedicaid
NC1275VOtherBCBS