Individual
SUZANNE M KEDDIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
202 MAPLEWOOD AVE, RONCEVERTE, WV 24970-1330
(304) 647-4411
Mailing address
202 MAPLEWOOD AVE, RONCEVERTE, WV 24970-1330
(304) 647-4411
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
0101058893
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005707731
—
VA
01
—
050073974
RR MEDICARE
VA
01
—
451751
ANTHEM
VA
05
—
5700559000
—
WV
Enumeration date
04/27/2006
Last updated
12/17/2012
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