1205827730 NPI number — W ALAN KEOGH DO

Table of content: W ALAN KEOGH DO (NPI 1205827730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205827730 NPI number — W ALAN KEOGH DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEOGH
Provider First Name:
W ALAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1205827730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 KIRKCALDY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19382-7285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-619-7420
Provider Business Mailing Address Fax Number:
610-876-6923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
STE 341
Provider Business Practice Location Address City Name:
UPLAND
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19013-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-619-7420
Provider Business Practice Location Address Fax Number:
610-876-6923
Provider Enumeration Date:
11/03/2005

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: 207RH0003X , with the licence number:  OS0003816L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RH0003X , with the licence number: 25MB07696300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: C20009108 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 001146510-0002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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