Provider Demographics
NPI:1861412850
Name:WHARTON, KEITH HAMILTON (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:HAMILTON
Last Name:WHARTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3572 BRODHEAD RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3101
Mailing Address - Country:US
Mailing Address - Phone:724-775-0800
Mailing Address - Fax:724-775-8038
Practice Address - Street 1:3572 BRODHEAD RD
Practice Address - Street 2:SUITE 301
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3101
Practice Address - Country:US
Practice Address - Phone:724-775-0800
Practice Address - Fax:724-775-8038
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033145E207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010173520004Medicaid
PA079806Medicare ID - Type Unspecified
PA0010173520004Medicaid