Provider Demographics
NPI:1063572204
Name:DOUGLAS L. KEAGLE D.O. P.C.
Entity type:Organization
Organization Name:DOUGLAS L. KEAGLE D.O. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KEAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-534-6310
Mailing Address - Street 1:1501 LANSDOWNE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1333
Mailing Address - Country:US
Mailing Address - Phone:610-534-6310
Mailing Address - Fax:610-534-6350
Practice Address - Street 1:1501 LANSDOWNE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1333
Practice Address - Country:US
Practice Address - Phone:610-534-6310
Practice Address - Fax:610-534-6350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003117L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty