| Lisa Keithley MD LLC | |
|
8186 Lark Brown Rd Ste 203 Elkridge MD 21075-6434 | |
| (410) 799-8931 | |
| Not Available |
| Full Name | Lisa Keithley MD LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 8186 Lark Brown Rd Ste 203, Elkridge, Maryland |
| Authorized Official Name and Position | Lisa Keithley (OWNER) |
| Authorized Official Contact | 4439262631 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa Keithley MD LLC 8186 Lark Brown Rd Ste 203 Elkridge MD 21075-6434 | Lisa Keithley MD LLC 8186 Lark Brown Rd Ste 203 Elkridge MD 21075-6434 Ph: (410) 799-8931 |
| NPI Number | 1063280758 |
|---|---|
| Provider Enumeration Date | 12/13/2023 |
| Last Update Date | 01/11/2024 |
| Certification Date | 01/11/2024 |
| Medicare PECOS PAC ID | 9931552049 |
|---|---|
| Medicare Enrollment ID | O20240125000412 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063280758 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Lisa I Keithley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760459887 PECOS PAC ID: 1557327517 Enrollment ID: I20090326000119 |
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