KEITH ANDREW DERCO (NPI# 1255424206) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255424206 |
| Entity Type | Individual |
| Full Name | KEITH ANDREW DERCO |
| Credential | M.D. |
| Practice Address |
11551 Nuckols Rd Suite F Glen Allen VA 23059-5565 |
| Practice Telephone | 8043644400 |
| Practice Fax Number | 8043640120 |
| Mailing Telephone | 8043644400 |
| Mailing Fax Number | 8043640120 |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2008-05-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 0101052086 | VA | Allopathic & Osteopathic Physicians |
| Street Address |
11551 NUCKOLS RD SUITE F |
| City | GLEN ALLEN |
| State | VA |
| Zip Code | 23059-5565 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497382378 | Taylor Delaine Zuchowski | Dietitian, Registered | 11551 Nuckols Rd, Glen Allen, VA 23059-5565 | 2020-03-23 |
| 1407232770 | Short Pump Wellness Clinic, LLC | Family Medicine | 11551 Nuckols Rd, Suite C, Glen Allen, VA 23059-5565 | 2015-08-10 |
| 1316324726 | Christina Wical | Nurse Practitioner | 11551 Nuckols Rd, Suite C, Glen Allen, VA 23059-5565 | 2015-05-05 |
| 1417388588 | Associates In Pediatrics | Pediatrics | 11551 Nuckols Rd, Suite F, Glen Allen, VA 23059-5565 | 2013-11-27 |
| 1831459080 | Joanne Sylvia Lane | Pediatrics | 11551 Nuckols Rd, Suite F, Glen Allen, VA 23059-5565 | 2012-05-22 |
| 1871749655 | Respiratory Specialties Company Lc | Durable Medical Equipment & Medical Supplies | 11551 Nuckols Rd, Suite N, Glen Allen, VA 23059-5565 | 2008-08-13 |
| 1235320854 | Helen Habtemichael | Nurse Practitioner | 11551 Nuckols Rd, Suite C, Glen Allen, VA 23059-5565 | 2007-08-08 |
| 1841413184 | Dominion Behavioral Healthcare | Counselor | 11551 Nuckols Rd, Suite F, Glen Allen, VA 23059-5565 | 2007-04-11 |
| 1225155781 | Associates In Pediatrics | Pediatrics | 11551 Nuckols Rd, Suite F, Glen Allen, VA 23059-5565 | 2007-03-22 |
| 1851422331 | Renita Walden Randolph | Dentist | 11551 Nuckols Rd, Suite A, Glen Allen, VA 23059-5565 | 2007-03-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003422163 | Kusum Bhetwal | Nurse Practitioner | 12804 Westin Estates Drive, Glen Allen, VA 23059 | 2020-09-23 |
| 1538704770 | Rise Services LLC | Community/Behavioral Health | 11357 Nuckois Road, Suite 2043, Glen Allen, VA 23059 | 2019-11-12 |
| 1992347116 | Irene Anne Mcgovern | Technician | 5233 Eastbranch Dr, Glen Allen, VA 23059 | 2019-10-09 |
| 1427547322 | Sharon Ann Lott | Audiologist | Short Pump Middle School, 4701 Pouncey Tract Road, Glen Allen, VA 23059 | 2018-05-07 |
| 1518476423 | Thomas Joseph Stein | Pharmacist | 4912 Old Millrace Place, Glen Allen, VA 23059 | 2017-09-22 |
| 1033638440 | Caroline Taylor | Specialist/Technologist | 5143 Dorin Hill Ct., Glen Allen, VA 23059 | 2017-09-18 |
| 1003335167 | Rva Transport, Inc. | Non-emergency Medical Transport (VAN) | 830 Brassie Ln, Apt F, Glen Allen, VA 23059 | 2017-09-10 |
| 1639628407 | Jessica Jasmine Green | Nurse Practitioner | 4687 Poucey Tract Road, Glen Allen, VA 23059 | 2016-09-22 |
| 1255512760 | Peggy Ellen York | Psychologist | 13314 Greenwood Rd, Glen Allen, VA 23059 | 2007-11-27 |
| 1689795940 | Kim Blassic | Dentist | 5225 Hickory Park Dr., Suite D, Glen Allen, VA 23059 | 2007-04-03 |
| Find all providers in zip 23059 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023422540 | Charlotte Anne Vellenoweth | Pediatrics | 11551 Nuckols Rd Ste F, Glen Allen, VA 23059-5565 | 2014-06-12 |
| 1740386911 | Robert E Kane IIi | Pediatrics | 10632 Toston Ln, Glen Allen, VA 23060-6498 | 2006-09-15 |
| 1255358065 | Pediatrics, Inc. | Pediatrics | 10571 Telegraph Road, Suite 110, Glen Allen, VA 23059 | 2006-07-16 |
| 1710912050 | Walter J Chun | Pediatrics | One Colonial Place, 10571 Telegraph Road, Glen Allen, VA 23059 | 2006-07-12 |
| 1831124593 | Jon Marks | Pediatrics | 10571 Telegraph Road, Suite 110, One Colonial Place, Glen Allen, VA 23059 | 2006-07-11 |
| 1134183700 | Olabisi Oyetokunbo Oshikanlu | Pediatrics | 2420 Old Brick Rd, Apt #1417, Glen Allen, VA 23060-5991 | 2006-04-12 |
| 1578563839 | Jeffrey E Bennett | Pediatrics | 4687 Pouncey Tract Rd, Glen Allen, VA 23059-5802 | 2005-07-28 |
| 1376543660 | Lisa D Chestnut | Pediatrics | 4687 Pouncey Tract Road, Kidmed, Glen Allen, VA 23059-5802 | 2005-07-28 |
| 1386183960 | Ann Carol Byrd | Pediatrics | 201 Concourse Blvd, Suite 110, Glen Allen, VA 23059-5640 | 2017-02-16 |
| 1518329234 | Advanced Skin and Laser Center of Richmond | Pediatrics | 201 Concourse Blvd, Suite 110, Glen Allen, VA 23059-5640 | 2016-03-22 |
| Find all providers in GLEN ALLEN | ||||
| City | GLEN ALLEN |
| Zip Code | 23059 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.