1669686358 NPI number — THOMAS M KEAHEY, MD, P.C.

Table of content: (NPI 1669686358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669686358 NPI number — THOMAS M KEAHEY, MD, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS M KEAHEY, MD, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1669686358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 19TH ST NW
Provider Second Line Business Mailing Address:
SUITE 420
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20036-3605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-452-1323
Provider Business Mailing Address Fax Number:
202-452-6822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 19TH ST NW
Provider Second Line Business Practice Location Address:
SUITE 420
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20036-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-452-1323
Provider Business Practice Location Address Fax Number:
202-452-6822
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KEAHEY
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
MARION
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
202-452-1323

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  MD14032 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0539179 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9456 . This is a "BLUECROSS BLUESHIELD" identifier . This identifiers is of the category "OTHER".




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