Basic Information
| Provider Information | |||||||||
| NPI: | 1982789798 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEERBS | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033965292 | ||||||||
| FaxNumber: | 7033965297 | ||||||||
| Practice Location | |||||||||
| Address1: | 8700 SUDLEY RD | ||||||||
| Address2: | |||||||||
| City: | MANASSAS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201104418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033965292 | ||||||||
| FaxNumber: | 7033965297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 08/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00038892 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | D0072238 | MD | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0101251163 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | MD040661 | DC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207QH0002X | 0101251163 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 130061000 | 05 | MD | MEDICAID | 8279168 | 05 | WA | MEDICAID | 268210 | 01 | INTERNAL ID-MOTOR VEHICLE ID | OTHER | 053601 | 01 | MEDICARE | OTHER |