Provider Demographics
NPI:1336101591
Name:KREITZ, KEITH A (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:KREITZ
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 1:211 DUPLIN STREET
Mailing Address - Street 2:
Mailing Address - City:KENANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28341-9024
Mailing Address - Country:US
Mailing Address - Phone:910-275-0027
Mailing Address - Fax:910-296-0214
Practice Address - Street 1:211 DUPLIN STREET
Practice Address - Street 2:
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349-9024
Practice Address - Country:US
Practice Address - Phone:910-275-0027
Practice Address - Fax:910-296-0214
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430162208600000X
LA15775R208600000X
NC2023-02847208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017391810005Medicaid
PA7933617OtherAETNA
PA1901798OtherHIGHMARK BLUE SHIELD
PA2768753000OtherKEYSTONE IBC
PA30211403OtherKEYSTONE FIRST
PAP01468758OtherRAILROAD MEDICINE
PA5300345OtherCIGNA PA
NC1336101591Medicaid
PAP01468758OtherRAILROAD MEDICINE