Provider Demographics
NPI:1275713455
Name:KEAH, JENNIFER HILLIARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HILLIARD
Last Name:KEAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:HILLIARD
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:495 THOMAS JONES WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2553
Mailing Address - Country:US
Mailing Address - Phone:610-524-4106
Mailing Address - Fax:610-524-4168
Practice Address - Street 1:495 THOMAS JONES WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2553
Practice Address - Country:US
Practice Address - Phone:610-524-4106
Practice Address - Fax:610-524-4168
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438264207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine