Provider Demographics
NPI:1679551782
Name:KEITH, DAVID K (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:KEITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 MASSILLON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7854
Mailing Address - Country:US
Mailing Address - Phone:330-899-9350
Mailing Address - Fax:330-899-9267
Practice Address - Street 1:3300 GREENWICH RD UNIT 8
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-5781
Practice Address - Country:US
Practice Address - Phone:330-825-7371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-007169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2262813Medicaid
H33889Medicare UPIN