MEDICARE: THOMAS M. KEAHEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NS0135X	Procedural Dermatology Physician	DOO29621	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437158177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS M. KEAHEY M.D.

Provider Business Mailing Address
First Line	:	15245 SHADY GROVE RD
Second Line	:	STE 370
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-6237
Country	:	US
Telephone Number	:	240-246-7417
Fax Number	:	240-477-4364

Provider Business Practice Location Address
First Line	:	19221 MONTGOMERY VILLAGE AVE
Second Line	:	C-12
City	:	MONTGOMERY VILLAGE
State	:	MD
Zip	:	20886-5022
Country	:	US
Telephone Number	:	301-840-2266
Fax Number	:	301-840-5879

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	06/06/2017

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