Provider Demographics
NPI:1851386742
Name:KEITH, ROSALIE C (DO)
Entity Type:Individual
Prefix:DR
First Name:ROSALIE
Middle Name:C
Last Name:KEITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:NY
Mailing Address - Zip Code:14802-1134
Mailing Address - Country:US
Mailing Address - Phone:607-587-9208
Mailing Address - Fax:607-587-9208
Practice Address - Street 1:100 W UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:ALFRED
Practice Address - State:NY
Practice Address - Zip Code:14802-1134
Practice Address - Country:US
Practice Address - Phone:607-587-9208
Practice Address - Fax:607-587-9208
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171396207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G14858Medicare UPIN