Basic Information
| Provider Information | |||||||||
| NPI: | 1093158883 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PY | ||||||||
| FirstName: | KIERAN | ||||||||
| MiddleName: | JEFFREY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10026 OLD OCEAN CITY BLVD | ||||||||
| Address2: | BUILDING #1 | ||||||||
| City: | BERLIN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218111288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106419450 | ||||||||
| FaxNumber: | 4106419515 | ||||||||
| Practice Location | |||||||||
| Address1: | 96 ATLANTIC AVE. | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | OCEAN VIEW | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199709116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3025414460 | ||||||||
| FaxNumber: | 3025410124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | C1-0011986 | DE | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.