Healthcare Provider Details

I. General information

NPI: 1407773229
Provider Name (Legal Business Name): KEEGAN OLIVER CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BREMO RD
RICHMOND VA
23226-1907
US

IV. Provider business mailing address

7406 PARKLINE DR
RICHMOND VA
23226-3804
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-2011
  • Fax:
Mailing address:
  • Phone: 540-457-0421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number0136001163
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: