Healthcare Provider Details

I. General information

NPI: 1972160224
Provider Name (Legal Business Name): SPENCER KEIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 HOSPITAL DR STE 201
STATE COLLEGE PA
16803-5500
US

IV. Provider business mailing address

155 WELLNESS WAY
STATE COLLEGE PA
16803-6702
US

V. Phone/Fax

Practice location:
  • Phone: 814-231-7888
  • Fax: 814-466-7489
Mailing address:
  • Phone: 814-231-7000
  • Fax: 814-238-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD476338
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: