Healthcare Provider Details

I. General information

NPI: 1245423011
Provider Name (Legal Business Name): STEPHEN NORBERT KEITH MD, MSPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 4TH ST NW APT. 1011
WASHINGTON DC
20001-4902
US

IV. Provider business mailing address

811 4TH ST NW APT. 1011
WASHINGTON DC
20001-4902
US

V. Phone/Fax

Practice location:
  • Phone: 410-733-6368
  • Fax:
Mailing address:
  • Phone: 410-733-6368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0036014
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG37534
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number67665
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: