Healthcare Provider Details

I. General information

NPI: 1730820119
Provider Name (Legal Business Name): KESWICK LO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N CREEK DR UNIT C
SUMMERVILLE SC
29486-5465
US

IV. Provider business mailing address

PO BOX 632516
CINCINNATI OH
45263-2516
US

V. Phone/Fax

Practice location:
  • Phone: 854-206-8590
  • Fax: 854-206-8591
Mailing address:
  • Phone: 888-472-0043
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number89813
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: