Provider Demographics
NPI:1659482420
Name:KEGLEY, MARY ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANNE
Last Name:KEGLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:ANNE
Other - Last Name:KEGLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:275 N EL CIELO RD STE 402D
Mailing Address - Street 2:DESERT OASIS HEALTHCARE
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6972
Mailing Address - Country:US
Mailing Address - Phone:760-320-8814
Mailing Address - Fax:
Practice Address - Street 1:4492 GRANGER ST
Practice Address - Street 2:AESCLEPIUS -MARY ANNE KEGLEY MD INC
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107
Practice Address - Country:US
Practice Address - Phone:276-608-1314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048930207Q00000X
CAG87180207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA930034796Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VAD43197Medicare UPIN
VA930000122Medicare ID - Type Unspecified