Provider Demographics
NPI:1902840945
Name:KEIM, JON A (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:A
Last Name:KEIM
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 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:545 W MAIN ST
Practice Address - Street 2:SUITE 11
Practice Address - City:TRAPPE
Practice Address - State:PA
Practice Address - Zip Code:19426
Practice Address - Country:US
Practice Address - Phone:610-489-9374
Practice Address - Fax:610-489-6418
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048414L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0331154000OtherAMERIHEALTH/INTERCOUNTY
PA163035OtherHIGHMARK BLUE SHIELD
PA2125273OtherALLIANCE/OPT CHC (MAMSI)
PA4291748OtherAETNA PPO
PA0015091240007Medicaid
PA0696535OtherCIGNA HMO/PPO
PA080184959OtherRRM
PA11045632OtherMULTIPLAN
PA3224116OtherAETNA HMO
PA11025245OtherCAQH ID#
PA1164062OtherKEYSTONE MERCY
PA0331154000OtherIBC - PC/KHPE
PA0696535OtherCIGNA HMO/PPO