Provider Demographics
NPI:1104939495
Name:SADEL, KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:SADEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 CHERRY LN FL 2
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3936
Mailing Address - Country:US
Mailing Address - Phone:215-357-2666
Mailing Address - Fax:215-357-2677
Practice Address - Street 1:715 CHERRY LN FL 2
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3936
Practice Address - Country:US
Practice Address - Phone:215-357-2666
Practice Address - Fax:215-357-2677
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069234L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA9416257OtherAETNA PPO ID
PA3580052001OtherKEYSTONE
PA6718044OtherAETNA HMO
PA0019200800001Medicaid
PA358005200OtherPC
H32132Medicare UPIN
PA045772ZCPEMedicare PIN