Provider Demographics
NPI:1780833970
Name:KEYKHAH, MOHAMMAD M (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:M
Last Name:KEYKHAH
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 1:21127 VALLEY FORGE CIR
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1198
Mailing Address - Country:US
Mailing Address - Phone:215-762-4312
Mailing Address - Fax:215-762-8656
Practice Address - Street 1:245 N 15TH ST # MS 310
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1101
Practice Address - Country:US
Practice Address - Phone:215-762-4312
Practice Address - Fax:215-762-8656
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035173L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA106737Medicare PIN
PAE81551Medicare UPIN