Provider Demographics
NPI:1326047853
Name:KEATING, JEFFREY M (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:KEATING
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 NORTH FURNACE STREET
Mailing Address - Street 2:SUITE 50
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508
Mailing Address - Country:US
Mailing Address - Phone:610-582-3668
Mailing Address - Fax:610-404-1644
Practice Address - Street 1:321 NORTH FURNACE STREET
Practice Address - Street 2:SUITE 50
Practice Address - City:BIRDSBORO
Practice Address - State:PA
Practice Address - Zip Code:19508
Practice Address - Country:US
Practice Address - Phone:610-582-3668
Practice Address - Fax:610-404-1644
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001824L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT27162Medicare UPIN