MEDICARE: GERALD E KEIGHTLEY M.D.

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
1	207RN0300X	Nephrology Physician	0101047191	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	59426	OTHER	VA	SOUTHERN HEALTH
2	052647	OTHER	VA	ANTHEM BLUE CROSS
3	202213	OTHER	VA	CIGNA
4	31247	OTHER	VA	CARENET
5	597421	OTHER	VA	AETNA
6	228371	OTHER	VA	MAMSI
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	541497804	OTHER		TRICARE CHAMPUS

General Provider Information

NPI Number	:	1447256482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD E KEIGHTLEY M.D.

Provider Business Mailing Address
First Line	:	8400 N RUN MEDICAL DR STE 200
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2319
Country	:	US
Telephone Number	:	804-559-6980
Fax Number	:	804-559-6982

Provider Business Practice Location Address
First Line	:	8400 N RUN MEDICAL DR STE 200
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116
Country	:	US
Telephone Number	:	804-559-6980
Fax Number	:	804-559-6982

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/22/2025

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Directions to “ GERALD E KEIGHTLEY M.D.” Practice Location

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