Healthcare Provider Details

I. General information

NPI: 1346457553
Provider Name (Legal Business Name): KEITH P BERKLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8364 BELL CREEK ROAD
MECHANICSVILLE VA
23116-3818
US

IV. Provider business mailing address

7130 GLEN FOREST DR SUITE 101
RICHMOND VA
23226-3754
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-4084
  • Fax: 804-559-2046
Mailing address:
  • Phone: 804-662-6138
  • Fax: 804-282-8678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101243930
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: