Provider Demographics
NPI:1952513160
Name:KECK-KESTER, TERRAH M (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRAH
Middle Name:M
Last Name:KECK-KESTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERRAH
Other - Middle Name:M
Other - Last Name:KECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:121 N NYES RD STE D
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-3248
Practice Address - Country:US
Practice Address - Phone:717-531-8674
Practice Address - Fax:717-531-0401
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD436301208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023070190001Medicaid
PA153382OtherMEDICARE