Provider Demographics
NPI:1427037621
Name:KESHGEGIAN, ALBERT A (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:A
Last Name:KESHGEGIAN
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 1:45 SUGAR MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2020
Mailing Address - Country:US
Mailing Address - Phone:610-356-6484
Mailing Address - Fax:
Practice Address - Street 1:45 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2020
Practice Address - Country:US
Practice Address - Phone:610-573-3746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018357E207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB37835Medicare UPIN