Provider Demographics
NPI:1295087187
Name:VANDERPOOL BS, KEITH BARRINGTON (RPSGT, RST, CSE)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:BARRINGTON
Last Name:VANDERPOOL BS
Suffix:
Gender:M
Credentials:RPSGT, RST, CSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 APOLLO DR STE 3309701
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4783
Mailing Address - Country:US
Mailing Address - Phone:301-925-4510
Mailing Address - Fax:301-925-4510
Practice Address - Street 1:9701 APOLLO DR STE 3309701
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774
Practice Address - Country:US
Practice Address - Phone:301-925-4510
Practice Address - Fax:301-925-4510
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2019-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDZ0000042247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other