Basic Information
| Provider Information | |||||||||
| NPI: | 1063478089 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUMMEL | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | TIMBERVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228532819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044566077 | ||||||||
| FaxNumber: | 5408397172 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 BUENA VISTA CIR | ||||||||
| Address2: | |||||||||
| City: | SOUTH HILL | ||||||||
| State: | VA | ||||||||
| PostalCode: | 239701431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4344473151 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 03/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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| NPICertificationDate: | 03/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 0101059259 | VA | N | Allopathic & Osteopathic Physicians | General Practice | 207P00000X | 0101059259 | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 010230641 | 05 | VA | MEDICAID |