Provider Demographics
NPI:1861557795
Name:RADBILL, KEITH P (DO)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:P
Last Name:RADBILL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:925 ROUTE 73 N STE H
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1277
Mailing Address - Country:US
Mailing Address - Phone:732-659-1159
Mailing Address - Fax:609-482-8024
Practice Address - Street 1:602 W. MAPLE AVE.
Practice Address - Street 2:
Practice Address - City:MERCHANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08109
Practice Address - Country:US
Practice Address - Phone:856-375-1500
Practice Address - Fax:609-482-8024
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07528500208D00000X, 207Q00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF95061Medicare UPIN