Provider Demographics
NPI:1306938923
Name:KEITH, PATRICK (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:KEITH
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 1:1878 MOUNTAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672
Mailing Address - Country:US
Mailing Address - Phone:802-253-4853
Mailing Address - Fax:
Practice Address - Street 1:186 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-8537
Practice Address - Country:US
Practice Address - Phone:802-334-3520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0010218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT3389370OtherCIGNA
VT4653401OtherVERMONT MANAGED CARE APEX
VT0VN2605Medicaid
VT353937OtherMVP
VT8000337OtherLADIES FIRST
VT00058268OtherBCBS
VT080183802OtherTRAVELERS MEDICARE
VT353937OtherMVP
VTH43844Medicare UPIN