Provider Demographics
NPI:1174639454
Name:BAIR, KEITH ALAN (PA)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ALAN
Last Name:BAIR
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:700 LAWN AVE
Mailing Address - Street 2:GRAND VIEW HOSPITAL - EMERGENCY
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1548
Mailing Address - Country:US
Mailing Address - Phone:215-453-4485
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:700 LAWN AVE
Practice Address - Street 2:GRAND VIEW HOSPITAL - EMERGENCY
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1548
Practice Address - Country:US
Practice Address - Phone:215-453-4485
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA052291363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant