Provider Demographics
NPI:1194810358
Name:KEYES, JANICE LYNN (MD)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:LYNN
Last Name:KEYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 REDWOOD SQUARE CTR STE 200
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-4267
Mailing Address - Country:US
Mailing Address - Phone:703-631-0331
Mailing Address - Fax:703-631-2573
Practice Address - Street 1:6101 REDWOOD SQUARE CTR STE 200
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-4267
Practice Address - Country:US
Practice Address - Phone:703-631-0331
Practice Address - Fax:703-631-2573
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039865207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5634571Medicaid
VA410125Medicare ID - Type Unspecified
VA5634571Medicaid