Provider Demographics
NPI:1356303051
Name:KEIM, DOUGLAS BRIAN (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:BRIAN
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 1:190 CAMPUS BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2872
Mailing Address - Country:US
Mailing Address - Phone:540-662-6135
Mailing Address - Fax:540-662-5845
Practice Address - Street 1:190 CAMPUS BLVD
Practice Address - Street 2:STE 200
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2872
Practice Address - Country:US
Practice Address - Phone:540-662-6135
Practice Address - Fax:540-662-5845
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053622207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2119678OtherMAMSI PROFESSIONAL
VA005802377Medicaid
08349300000OtherQUALCHOICE
WV3810003817OtherWV MEDICAID GROUP
C00085OtherVA MEDICARE B - GROUP #
222409OtherANTHEM PROFESSIONAL
43937OtherSENTARA PROFESSIONAL
000875693OtherWV BLUE SHIELD - GROUP #
WV0080498000Medicaid
000952284OtherWV BLUE SHIELD
VA005802377Medicaid
08349300000OtherQUALCHOICE