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NPI Code Detail

MEDICARE: MR. KEITH LODGE M.S.ED

MEDICARE: MR. KEITH LODGE M.S.ED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorPC005906PA

General Provider Information

NPI Number : 1104084714
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEITH LODGE M.S.ED
Provider Business Mailing Address
First Line : 353 N DUFFY RD
Second Line :
City : BUTLER
State : PA
Zip : 16001-1138
Country : US
Telephone Number : 878-271-6546
Fax Number :
Provider Business Practice Location Address
First Line : 353 N DUFFY RD
Second Line :
City : BUTLER
State : PA
Zip : 16001-1138
Country : US
Telephone Number : 878-271-6546
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2008
Last Update Date : 12/03/2025

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