Basic Information
| Provider Information | |||||||||
| NPI: | 1174535587 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VOMEIGEN | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 COVENTRY ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061121548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607142813 | ||||||||
| FaxNumber: | 8607148541 | ||||||||
| Practice Location | |||||||||
| Address1: | 131 COVENTRY ST | ||||||||
| Address2: | BURGDORF CLINIC 2ND FLOOR - ADMINISTRATION | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061121548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607142813 | ||||||||
| FaxNumber: | 8607148541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 07/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 035520 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001355206-CL | 05 | CT | MEDICAID |