Healthcare Provider Details

I. General information

NPI: 1679551782
Provider Name (Legal Business Name): DAVID K. KEITH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GREENWICH RD UNIT 8
NORTON OH
44203-5781
US

IV. Provider business mailing address

3515 MASSILLON RD STE 300
UNIONTOWN OH
44685-7854
US

V. Phone/Fax

Practice location:
  • Phone: 330-825-7371
  • Fax:
Mailing address:
  • Phone: 330-899-9350
  • Fax: 330-899-9267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-007169
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: