Basic Information
| Provider Information | |||||||||
| NPI: | 1346269693 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKEAGUE | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3421 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177418003 | ||||||||
| FaxNumber: | 7174617404 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 MONUMENT RD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174035060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177418003 | ||||||||
| FaxNumber: | 7174617404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 06/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD065499L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01110701 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 1142282 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 034594 | 01 | PA | JOHNS HOPKINS | OTHER | 257479 | 01 | PA | MAMSI-WMG | OTHER | 71754 | 01 | PA | GEISINGER | OTHER | P002845 | 01 | PA | GATEWAY-WMG | OTHER | 001705592 | 05 | PA | MEDICAID | 645005 | 01 | MD | CAREFIRST MD BCBS | OTHER | 82049 | 01 | PA | UNISON-WMG | OTHER | 0695033000 | 01 | PA | AMERIHEALTH 65 PA | OTHER | 7937243 | 01 | PA | AETNA | OTHER | 975592 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |