Healthcare Provider Details

I. General information

NPI: 1275742835
Provider Name (Legal Business Name): MARYA KECK MDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 SHAFFER PKWY
LITTLETON CO
80127-3004
US

IV. Provider business mailing address

7600 SHAFFER PKWY
LITTLETON CO
80127-3004
US

V. Phone/Fax

Practice location:
  • Phone: 303-743-5855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: