Basic Information
Provider Information
NPI: 1821080029
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KEIM
FirstName: STEPHEN
MiddleName: GEORGE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 E CARROLL ST
Address2:  
City: SALISBURY
State: MD
PostalCode: 218015422
CountryCode: US
TelephoneNumber: 4105466400
FaxNumber:  
Practice Location
Address1: 106 MILFORD ST
Address2: SUITE 605
City: SALISBURY
State: MD
PostalCode: 218046953
CountryCode: US
TelephoneNumber: 4103342224
FaxNumber: 4103343962
Other Information
ProviderEnumerationDate: 08/16/2005
LastUpdateDate: 09/03/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000XD0032212MDN Other Service ProvidersSpecialist 
207RC0001XD0032212MDY Allopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology

No ID Information.


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