Provider Demographics
NPI:1699733295
Name:KEAY, SUSAN KAY (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KAY
Last Name:KEAY
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:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-705-6450
Mailing Address - Fax:410-705-7837
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-705-6450
Practice Address - Fax:410-705-7837
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD37851207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0209417000Medicaid
MD52422002 & 01OtherBC/BS
VA5852463Medicaid
MD526341700Medicaid
DC036608200Medicaid
DE1699733295Medicaid
MD110123047Medicare PIN
MDS033S359Medicare PIN
MD52422002 & 01OtherBC/BS
WV0209417000Medicaid