1316696560 NPI number — KEISHA PATRICIA TARGET MD

Table of content: KEISHA PATRICIA TARGET MD (NPI 1316696560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316696560 NPI number — KEISHA PATRICIA TARGET MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TARGET
Provider First Name:
KEISHA
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316696560
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ROCKLEY GOLF & COUNTRY CLUB, GOLF CLUB ROAD
Provider Second Line Business Mailing Address:
APT 225 GOLDEN GROVE CLUSTER
Provider Business Mailing Address City Name:
BRIDGETOWN
Provider Business Mailing Address State Name:
CHRIST CHURCH
Provider Business Mailing Address Postal Code:
BB15121
Provider Business Mailing Address Country Code:
BB
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
58 SILVER MOON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20904-1249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-305-6594
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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