Provider Demographics
NPI:1053688804
Name:HULL, KEITH MARK (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:MARK
Last Name:HULL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18315 LEEDSTOWN WAY
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-3135
Mailing Address - Country:US
Mailing Address - Phone:301-774-7831
Mailing Address - Fax:
Practice Address - Street 1:18315 LEEDSTOWN WAY
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-3135
Practice Address - Country:US
Practice Address - Phone:301-774-7831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063885207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology