Provider Demographics
NPI:1447256482
Name:KEIGHTLEY, GERALD E (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:E
Last Name:KEIGHTLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 71122
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28272-1122
Mailing Address - Country:US
Mailing Address - Phone:804-559-6980
Mailing Address - Fax:804-559-6982
Practice Address - Street 1:8400 N RUN MEDICAL DR STE 200
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116
Practice Address - Country:US
Practice Address - Phone:804-559-6980
Practice Address - Fax:804-559-6982
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101047191207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA228371OtherMAMSI
VA6041396Medicaid
VA597421OtherAETNA
VA31247OtherCARENET
541497804OtherTRICARE CHAMPUS
VA202213OtherCIGNA
VA59426OtherSOUTHERN HEALTH
VA052647OtherANTHEM BLUE CROSS
VA202213OtherCIGNA
VA59426OtherSOUTHERN HEALTH