Healthcare Provider Details

I. General information

NPI: 1851386742
Provider Name (Legal Business Name): ROSALIE C KEITH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W UNIVERSITY ST
ALFRED NY
14802-1134
US

IV. Provider business mailing address

100 W UNIVERSITY ST
ALFRED NY
14802-1134
US

V. Phone/Fax

Practice location:
  • Phone: 607-587-9208
  • Fax: 607-587-9208
Mailing address:
  • Phone: 607-587-9208
  • Fax: 607-587-9208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number171396
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: