Provider Demographics
NPI:1205815479
Name:TYSON, KEITH F (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:F
Last Name:TYSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2300 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9627
Mailing Address - Country:US
Mailing Address - Phone:717-757-3537
Mailing Address - Fax:717-718-9701
Practice Address - Street 1:1010 EICHELBERGER ST
Practice Address - Street 2:SUITE 4
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1374
Practice Address - Country:US
Practice Address - Phone:717-757-3537
Practice Address - Fax:717-718-9701
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005821213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021748160001Medicaid
PA50053764OtherCAPITAL BLUE CROSS
PA093855HDXMedicare PIN
PAV06212Medicare UPIN