Healthcare Provider Details

I. General information

NPI: 1316558216
Provider Name (Legal Business Name): KEELEY DIGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 MARVEL CT
EASTON MD
21601-4053
US

IV. Provider business mailing address

2621 JAMAICA POINT RD
TRAPPE MD
21673-1619
US

V. Phone/Fax

Practice location:
  • Phone: 410-819-8867
  • Fax:
Mailing address:
  • Phone: 410-463-0376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: