Healthcare Provider Details

I. General information

NPI: 1538197876
Provider Name (Legal Business Name): JOHN KEATS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PKWY
ANNAPOLIS MD
21401-3773
US

IV. Provider business mailing address

301 HOSPITAL DR
GLEN BURNIE MD
21061-5803
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-1750
  • Fax: 443-481-1687
Mailing address:
  • Phone: 443-481-6469
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG40092
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD80816
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: