Provider Demographics
NPI:1205827730
Name:KEOGH, W ALAN (DO)
Entity type:Individual
Prefix:
First Name:W ALAN
Middle Name:
Last Name:KEOGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 KIRKCALDY DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7285
Mailing Address - Country:US
Mailing Address - Phone:610-619-7420
Mailing Address - Fax:610-876-6923
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:STE 341
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-619-7420
Practice Address - Fax:610-876-6923
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0003816L207RH0003X
NJ25MB07696300207RH0003X
DEC20009108207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001146510-0002Medicaid
PA133065G48Medicare PIN
NJ079354RVOMedicare PIN
PA001146510-0002Medicaid
B37909Medicare UPIN