Provider Demographics
NPI:1972575462
Name:KEIM, MELVIN N (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:N
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 1:53 S MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2333
Mailing Address - Country:US
Mailing Address - Phone:540-932-5668
Mailing Address - Fax:540-932-5688
Practice Address - Street 1:53 S MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2333
Practice Address - Country:US
Practice Address - Phone:540-932-5668
Practice Address - Fax:540-932-5688
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101019290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10972OtherCIGNA
VA71987OtherSOUTHERN HEALTH
VA284220OtherANTHEM
VA5640008OtherVA PREMIER
VA21983OtherOPTIMA
VA5640008OtherVA PREMIER
VAC00264Medicare PIN