Provider Demographics
NPI:1801883772
Name:MCKEOWN, JOSEPH EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:MCKEOWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 N RIDGE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-7404
Mailing Address - Country:US
Mailing Address - Phone:804-288-0101
Mailing Address - Fax:804-288-0850
Practice Address - Street 1:420 N RIDGE RD
Practice Address - Street 2:STE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-7404
Practice Address - Country:US
Practice Address - Phone:804-288-0101
Practice Address - Fax:804-288-0850
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010425762086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6901026Medicaid
E48777Medicare UPIN