Provider Demographics
NPI:1346357084
Name:KEEVER, NATHAN E (MD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:E
Last Name:KEEVER
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 1:194 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORISKANY FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13425-0700
Mailing Address - Country:US
Mailing Address - Phone:315-821-7277
Mailing Address - Fax:315-821-7278
Practice Address - Street 1:194 M AIN ST
Practice Address - Street 2:
Practice Address - City:ORISKANY FALLS
Practice Address - State:NY
Practice Address - Zip Code:13425-0700
Practice Address - Country:US
Practice Address - Phone:315-821-7277
Practice Address - Fax:315-821-7278
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1671441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01130116Medicaid
NY01130116Medicaid
NY53310AMedicare PIN