1326001306 NPI number — KEITH J WRIGHT MD

Table of content: KEITH J WRIGHT MD (NPI 1326001306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326001306 NPI number — KEITH J WRIGHT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRIGHT
Provider First Name:
KEITH
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1326001306
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3421 CONCORD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17402-9001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-806-3800
Provider Business Mailing Address Fax Number:
717-806-3799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1135 GEORGETOWN RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
CHRISTIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17509-9543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-806-3800
Provider Business Practice Location Address Fax Number:
717-806-3799
Provider Enumeration Date:
04/10/2006

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: 171100000X , with the licence number:  PAK000200 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD00032572 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD053840L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5975114 . This is a "AETNA PROV #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 188431 . This is a "LABOR & INDUSTRIES #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1021123770001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50077762 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9160WR . This is a "REGENCE PROV #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8178378 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: WR2020776 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: J8131-03 . This is a "PACIFIC SOURCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 50051184 . This is a "CAPTIAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".