Provider Demographics
NPI:1346269693
Name:MCKEAGUE, MARK ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:MCKEAGUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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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:717-741-8003
Mailing Address - Fax:717-461-7404
Practice Address - Street 1:25 MONUMENT RD
Practice Address - Street 2:SUITE 140
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5060
Practice Address - Country:US
Practice Address - Phone:717-741-8003
Practice Address - Fax:717-461-7404
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065499L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01110701OtherCAPITAL BLUE CROSS-WMG
PA1142282OtherAMERIHEALTH MERCY-WMG
PA034594OtherJOHNS HOPKINS
PA257479OtherMAMSI-WMG
PA71754OtherGEISINGER
PAP002845OtherGATEWAY-WMG
PA001705592Medicaid
MD645005OtherCAREFIRST MD BCBS
PA82049OtherUNISON-WMG
PA0695033000OtherAMERIHEALTH 65 PA
PA7937243OtherAETNA
PA975592OtherHIGHMARK BLUE SHIELD
PA1142282OtherAMERIHEALTH MERCY-WMG
MD645005OtherCAREFIRST MD BCBS
PA110179792Medicare PIN