Provider Demographics
NPI:1457438616
Name:KEITH, MARIE BACHTHALER (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:BACHTHALER
Last Name:KEITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 BROADWAY
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3922
Mailing Address - Country:US
Mailing Address - Phone:212-334-3366
Mailing Address - Fax:212-334-3981
Practice Address - Street 1:552 BROADWAY
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3922
Practice Address - Country:US
Practice Address - Phone:212-334-3366
Practice Address - Fax:212-334-3981
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128244208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics