Provider Demographics
NPI:1861469827
Name:SHENBERGER, KEITH
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:SHENBERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:SUITE 101-103
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1705 WARREN AVE
Practice Address - Street 2:SUITE 101-103
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-2647
Practice Address - Country:US
Practice Address - Phone:570-321-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021221E207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA538445OtherAETNA
PA073420OtherFIRST PRIORITY HEALTH
PA69792OtherHIGHMARK BLUE SHIELD
PA1552244OtherUNITEDHEALTHCARE
PA0011370470005Medicaid
PA110179694Medicare PIN
PA538445OtherAETNA
PA0011370470003Medicaid
PA1552244OtherUNITEDHEALTHCARE
PAB34876OtherHEALTHAMERICA
PA110179694Medicare PIN