Provider Demographics
NPI:1841398633
Name:OKEEFE, KEVIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:OKEEFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2003 MEDICAL PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-573-1110
Mailing Address - Fax:410-266-0714
Practice Address - Street 1:2003 MEDICAL PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-573-1110
Practice Address - Fax:410-266-0714
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035259207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0005OtherBCBS
P171052OtherPRINCIPLE
0402087OtherUNITED HEALTHCARE
P15408OtherBCBS POINT OF SERVICE
110242066OtherMEDICARE RAILROAD
297024OtherMDIPA
297024OtherMAMSI
MD42428510OtherBCBS
1496254OtherUNITED MINE WORKERS ASSOC
4421835OtherAETNA
521899197OtherMAMSI
MDKS82GROtherBCBS
297024OtherMDIPA
297024OtherMAMSI