Healthcare Provider Details

I. General information

NPI: 1982606810
Provider Name (Legal Business Name): KEITH R. DIXON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

38 MEADOWLANDS PKWY STE 205
SECAUCUS NJ
07094-2925
US

V. Phone/Fax

Practice location:
  • Phone: 860-837-5890
  • Fax:
Mailing address:
  • Phone: 551-257-7015
  • Fax: 551-257-7025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA07638600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number25MA07638600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: