Provider Demographics
NPI:1437902905
Name:MCKEEVER, DYLAN MATTHEW
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:MATTHEW
Last Name:MCKEEVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925-1354
Mailing Address - Country:US
Mailing Address - Phone:215-512-8159
Mailing Address - Fax:
Practice Address - Street 1:100 ST LUKES LN
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-6217
Practice Address - Country:US
Practice Address - Phone:212-272-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant