1275713455 NPI number — DR. JENNIFER HILLIARD KEAH M.D.

Table of content: DR. JENNIFER HILLIARD KEAH M.D. (NPI 1275713455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275713455 NPI number — DR. JENNIFER HILLIARD KEAH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEAH
Provider First Name:
JENNIFER
Provider Middle Name:
HILLIARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
HILLIARD
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275713455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
495 THOMAS JONES WAY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
EXTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19341-2553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-524-4106
Provider Business Mailing Address Fax Number:
610-524-4168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
495 THOMAS JONES WAY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
EXTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19341-2553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-524-4106
Provider Business Practice Location Address Fax Number:
610-524-4168
Provider Enumeration Date:
11/06/2007

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: 207Q00000X , with the licence number:  MD438264 , 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)





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