Superdock, Keith Robert

Superdock, Keith Robert is an individual health care provider with primary practice located at 701 Grove Rd , Greenville SC 29605-4210. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as his primary health care specialty. Superdock, Keith Robert can be contacted via phone (864) 455-5648.

Contact Information

Primary practice address
701 Grove Rd Greenville SC 29605-4210
Phone: (864) 455-5648
Fax: (864) 455-7862
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X MD049781L Pennsylvania
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 85922 South Carolina

Profile Details

NPI number 1700874021
LBN Legal business name Superdock, Keith Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 11th, 2005
Last updated Jul 21st, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700874021 NPPES
Pennsylvania MEDICAID 0014136400001
Pennsylvania MEDICAID PENDING

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