Healthcare Provider Details

I. General information

NPI: 1962197772
Provider Name (Legal Business Name): MICHAEL DALTON KEITER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VCUHS DEPT OF PSYCHIATRY #980710
RICHMOND VA
23298-5023
US

IV. Provider business mailing address

VCUHS GME ADMINISTRATION, BOX 980257
RICHMOND VA
23298-5021
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-7912
  • Fax:
Mailing address:
  • Phone: 804-828-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1962197772
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: