Basic Information
| Provider Information | |||||||||
| NPI: | 1962477349 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRISON | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | POTTSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194643241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103274200 | ||||||||
| FaxNumber: | 6103278160 | ||||||||
| Practice Location | |||||||||
| Address1: | 23 N WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | BOYERTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 195121467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103672259 | ||||||||
| FaxNumber: | 6103670505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2006 | ||||||||
| LastUpdateDate: | 12/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS005855L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.