Healthcare Provider Details

I. General information

NPI: 1548320211
Provider Name (Legal Business Name): KEITH L HIATT MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KELLER ARMY COMMUNITY HOSPITAL 900 WASHINGTON ROAD ATTN CREDENTIALS
WEST POINT MILITARY RESERVATION NY
10996-0001
US

IV. Provider business mailing address

KELLER ARMY COMMUNITY HOSPITAL 900 WASHINGTON ROAD ATTN CREDENTIALS
WEST POINT MILITARY RESERVATION NY
10996-0001
US

V. Phone/Fax

Practice location:
  • Phone: 845-938-3470
  • Fax: 845-938-6660
Mailing address:
  • Phone: 845-938-3470
  • Fax: 845-938-6660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number031440
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number031440
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: