Provider Demographics
NPI:1275574956
Name:LEPP, KEITH A (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:LEPP
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 1:99 PAINE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-4147
Mailing Address - Country:US
Mailing Address - Phone:914-235-9448
Mailing Address - Fax:
Practice Address - Street 1:20 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5238
Practice Address - Country:US
Practice Address - Phone:203-629-2822
Practice Address - Fax:203-629-2940
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0258832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT025883OtherSTATE PHYSICIAN LICENSE
CTAL9185364OtherDEA REGISTRATION
CT260000859Medicare ID - Type Unspecified
CTAL9185364OtherDEA REGISTRATION