1326001306 NPI number — KEITH J WRIGHT MD

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

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 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:

1326001306

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/24/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

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 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

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• 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" .

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