Provider Demographics
NPI:1184822827
Name:JEFFREY M KEEGAN MD PC
Entity Type:Organization
Organization Name:JEFFREY M KEEGAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KEEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-379-9255
Mailing Address - Street 1:11301 POLO PL STE B
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-4803
Mailing Address - Country:US
Mailing Address - Phone:804-379-9255
Mailing Address - Fax:804-379-6293
Practice Address - Street 1:11301 POLO PL STE B
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4803
Practice Address - Country:US
Practice Address - Phone:804-379-9255
Practice Address - Fax:804-379-6293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB09059Medicare UPIN
VAC02955Medicare PIN