Provider Demographics
NPI:1306952601
Name:KEYSER, MARIAN J (DO)
Entity type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:J
Last Name:KEYSER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 411
Mailing Address - Street 2:JOHNSTON COUNTY MENTAL HEALTH CENTER
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-0411
Mailing Address - Country:US
Mailing Address - Phone:919-989-5500
Mailing Address - Fax:919-989-5532
Practice Address - Street 1:521 N BRIGHTLEAF BLVD
Practice Address - Street 2:JOHNSTON COUNTY MENTAL HEALTH CENTER
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4407
Practice Address - Country:US
Practice Address - Phone:919-989-5500
Practice Address - Fax:919-989-5532
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94012352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
136E8OtherBCBS-PPO
NC89136E8Medicaid
NC89136E8Medicaid
E43874Medicare UPIN
2492747AMedicare PIN