Healthcare Provider Details

I. General information

NPI: 1518967645
Provider Name (Legal Business Name): KEITH J EDINBURGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CARNIE BLVD STE B5
VOORHEES NJ
08043-4514
US

IV. Provider business mailing address

700 E MOREHEAD ST STE 300
CHARLOTTE NC
28202-2742
US

V. Phone/Fax

Practice location:
  • Phone: 888-909-7572
  • Fax:
Mailing address:
  • Phone: 856-229-0696
  • Fax: 763-694-9000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA12092900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number41611
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number41611
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number41611
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number41611
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: