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Individual
DR. WALLACE KEITH AMMON
Active
Individual
DR. WALLACE KEITH AMMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD427608
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100434
GEISINGER
PA
05
—
101445370
—
PA
01
—
103042
JOHNS HOPKINS
PA
01
—
1789885
HIGHMARK BLUE SHIELD
PA
01
—
2626996000
AMERIHEALTH 65 PA
PA
01
—
7107935
AETNA
PA
01
—
891000
CAREFIRST MD BCBS
MD
Enumeration date
12/12/2006
Last updated
01/16/2021
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