Provider Demographics
NPI:1669686358
Name:THOMAS M KEAHEY, MD, P.C.
Entity Type:Organization
Organization Name:THOMAS M KEAHEY, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:KEAHEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-452-1323
Mailing Address - Street 1:1120 19TH ST NW
Mailing Address - Street 2:SUITE 420
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-3605
Mailing Address - Country:US
Mailing Address - Phone:202-452-1323
Mailing Address - Fax:202-452-6822
Practice Address - Street 1:1120 19TH ST NW
Practice Address - Street 2:SUITE 420
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3605
Practice Address - Country:US
Practice Address - Phone:202-452-1323
Practice Address - Fax:202-452-6822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD14032207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0539179OtherAETNA
9456OtherBLUECROSS BLUESHIELD
0539179OtherAETNA