Provider Demographics
NPI:1528245347
Name:KECK, TATIANA BORISOVNA (MD)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:BORISOVNA
Last Name:KECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:BORISOVNA
Other - Last Name:MOLYAKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:933 FIRST COLONIAL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3172
Mailing Address - Country:US
Mailing Address - Phone:757-491-7359
Mailing Address - Fax:757-491-9359
Practice Address - Street 1:933 FIRST COLONIAL RD STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3172
Practice Address - Country:US
Practice Address - Phone:757-491-7359
Practice Address - Fax:757-491-9359
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2025-07-21
Deactivation Date:2025-06-10
Deactivation Code:
Reactivation Date:2025-07-21
Provider Licenses
StateLicense IDTaxonomies
WI51231207R00000X
VA0101255588207RR0500X
VA101255588207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine