Provider Demographics
NPI:1578645107
Name:NEPHROLOGY SPECIALISTS PC
Entity Type:Organization
Organization Name:NEPHROLOGY SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:KEIGHTLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:804-559-6980
Mailing Address - Street 1:PO BOX 25807
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2009
Mailing Address - Country:US
Mailing Address - Phone:804-559-6980
Mailing Address - Fax:804-559-6982
Practice Address - Street 1:8400 N RUN MEDICAL DR STE 200
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116
Practice Address - Country:US
Practice Address - Phone:804-559-6980
Practice Address - Fax:804-559-6982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6746OtherMEDICARE RR
CA6746OtherMEDICARE RR