Provider Demographics
NPI:1548320211
Name:HIATT, KEITH L (MD MPH)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:L
Last Name:HIATT
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KELLER ARMY COMMUNITY HOSPITAL 900 WASHINGTON ROAD
Mailing Address - Street 2:ATTN CREDENTIALS
Mailing Address - City:WEST POINT MILITARY RESERVATION
Mailing Address - State:NY
Mailing Address - Zip Code:10996-0001
Mailing Address - Country:US
Mailing Address - Phone:845-938-3470
Mailing Address - Fax:845-938-6660
Practice Address - Street 1:KELLER ARMY COMMUNITY HOSPITAL 900 WASHINGTON ROAD
Practice Address - Street 2:ATTN CREDENTIALS
Practice Address - City:WEST POINT MILITARY RESERVATION
Practice Address - State:NY
Practice Address - Zip Code:10996-0001
Practice Address - Country:US
Practice Address - Phone:845-938-3470
Practice Address - Fax:845-938-6660
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0314402083A0100X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Not Answered2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD 000Medicare UPIN