Provider Demographics
NPI:1265459341
Name:ALBERTSON, KEITH SUMNER (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:SUMNER
Last Name:ALBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9379 FORESTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4701
Mailing Address - Country:US
Mailing Address - Phone:703-393-1667
Mailing Address - Fax:703-361-2429
Practice Address - Street 1:9379 FORESTWOOD LN
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4701
Practice Address - Country:US
Practice Address - Phone:703-393-1667
Practice Address - Fax:703-361-2429
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00W516K07Medicare ID - Type Unspecified
VAI24210Medicare UPIN