Provider Demographics
NPI:1376537266
Name:KEYS, WILLIAM (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:KEYS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 MANCHESTER RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-1802
Mailing Address - Country:US
Mailing Address - Phone:410-374-8100
Mailing Address - Fax:410-374-8104
Practice Address - Street 1:2975 MANCHESTER RD
Practice Address - Street 2:UNIT A
Practice Address - City:MANCHESTER
Practice Address - State:MD
Practice Address - Zip Code:21102-1802
Practice Address - Country:US
Practice Address - Phone:410-374-8100
Practice Address - Fax:410-374-8104
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041962174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF35424Medicare UPIN