Provider Demographics
NPI:1245396019
Name:KEARNEY, KEITH RICHARD (DO)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:RICHARD
Last Name:KEARNEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 BETHLEHEM PIKE
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1454
Mailing Address - Country:US
Mailing Address - Phone:215-257-3011
Mailing Address - Fax:215-257-3437
Practice Address - Street 1:1107 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1454
Practice Address - Country:US
Practice Address - Phone:215-257-3011
Practice Address - Fax:215-257-3437
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013772207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024557550001Medicaid
PA109286Medicare PIN
PA1024557550001Medicaid