=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205815479
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEITH F. TYSON D.P.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2006
-----------------------------------------------------
Last Update Date | 06/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 EICHELBERGER ST SUITE 4
-----------------------------------------------------
City | HANOVER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17331-1374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-757-3537
-----------------------------------------------------
Fax | 717-718-9701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2300 PLEASANT VALLEY RD
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17402-9627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-757-3537
-----------------------------------------------------
Fax | 717-718-9701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | SC005821
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | SC005821
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------