Provider Demographics
NPI:1215079603
Name:HANGER, KEITH ELWOOD (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:ELWOOD
Last Name:HANGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606
Mailing Address - Country:US
Mailing Address - Phone:757-232-8777
Mailing Address - Fax:757-232-8866
Practice Address - Street 1:4125 IRONBOUND ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188
Practice Address - Country:US
Practice Address - Phone:757-565-0600
Practice Address - Fax:757-565-0553
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2009-12-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101019263207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1215079603Medicaid
VAB06979Medicare UPIN
VA01942T25Medicare PIN