Healthcare Provider Details

I. General information

NPI: 1164642625
Provider Name (Legal Business Name): MARGARET JESSICA KEITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 MEDICAL PKWY
ANNAPOLIS MD
21401-7992
US

IV. Provider business mailing address

1230 QUINN ST
JACKSON MS
39202-2161
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-9700
  • Fax:
Mailing address:
  • Phone: 601-988-7054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License NumberD0065545
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: