Provider Demographics
NPI:1265494280
Name:KEAMY, LISA (MD)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:KEAMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6080 FALLS RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2230
Mailing Address - Country:US
Mailing Address - Phone:410-323-2757
Mailing Address - Fax:410-323-2715
Practice Address - Street 1:6080 FALLS RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2230
Practice Address - Country:US
Practice Address - Phone:410-323-2757
Practice Address - Fax:410-323-2715
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD45515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD146391800Medicaid
MD146391800Medicaid
MDK45316BBMedicare ID - Type Unspecified