Provider Demographics
NPI:1699775825
Name:KEAGY, GREGORY STEPHEN (DO)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:STEPHEN
Last Name:KEAGY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2153 VALLEYGATE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3681
Mailing Address - Country:US
Mailing Address - Phone:910-672-0350
Mailing Address - Fax:910-672-0355
Practice Address - Street 1:2153 VALLEYGATE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3681
Practice Address - Country:US
Practice Address - Phone:910-672-0350
Practice Address - Fax:910-672-0355
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003768208G00000X
NC2008-00484208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2467272Medicaid
OH4124793Medicare PIN
B41329Medicare UPIN
OH4124791Medicare PIN