Provider Demographics
NPI:1326001306
Name:WRIGHT, KEITH J (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:J
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-806-3800
Mailing Address - Fax:717-806-3799
Practice Address - Street 1:1135 GEORGETOWN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CHRISTIANA
Practice Address - State:PA
Practice Address - Zip Code:17509-9543
Practice Address - Country:US
Practice Address - Phone:717-806-3800
Practice Address - Fax:717-806-3799
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPAK000200171100000X
WAMD00032572207Q00000X
PAMD053840L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9160WROtherREGENCE PROV #
PAWR2020776OtherHIGHMARK BLUE SHIELD
WA5975114OtherAETNA PROV #
WA188431OtherLABOR & INDUSTRIES #
WAJ8131-03OtherPACIFIC SOURCE
PA1021123770001Medicaid
PA50077762OtherCAPITAL BLUE CROSS
WA8178378Medicaid
50051184OtherCAPTIAL BLUE CROSS
PA1021123770001Medicaid
PA1021123770001Medicaid