Individual
MR. KEITH CHARLES DAMICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
5235 NC 226 S, MARION, NC 28752-8733
(828) 766-7278
(822) 766-2849
Mailing address
PO BOX 448, CROSSNORE, NC 28616-0448
(828) 766-7278
(822) 766-2849
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
102719
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89018TB
—
NC
Enumeration date
11/08/2006
Last updated
07/30/2009
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