Provider Demographics
NPI:1073613733
Name:KEITH, ROBERT (MPA, PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:KEITH
Suffix:
Gender:M
Credentials:MPA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SCHOOL ST
Mailing Address - Street 2:STE 1
Mailing Address - City:ALBION
Mailing Address - State:ME
Mailing Address - Zip Code:04910-6501
Mailing Address - Country:US
Mailing Address - Phone:207-864-2699
Mailing Address - Fax:207-864-2969
Practice Address - Street 1:7 SCHOOL ST STE 1
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:ME
Practice Address - Zip Code:04910
Practice Address - Country:US
Practice Address - Phone:207-437-9388
Practice Address - Fax:207-437-2557
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1594363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMK1402635OtherDEA NUMBER
MEMK3849722OtherDEA