Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 0101033509 | VA |
NPI | 1588752398 |
---|---|
Provider Name | Mr. Daniel Edward Keim |
First Address | Fairfax, VA 22031-4360 |
Second Address | Fairfax, VA 22031-4360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 29/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006739792 | (05) | VA |
B94324 | (02) |