Provider Demographics
NPI:1578525309
Name:PUMROY, KEITH S (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:S
Last Name:PUMROY
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 1:4 RICE HOPE CT
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-3113
Mailing Address - Country:US
Mailing Address - Phone:717-645-2387
Mailing Address - Fax:
Practice Address - Street 1:4 RICE HOPE CT
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-3113
Practice Address - Country:US
Practice Address - Phone:717-645-2387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034893E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012833680008Medicaid
PA0012833680008Medicaid
PAF07745Medicare UPIN