W. Dale Keckley, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

001065 Issued in CT

Practice address

263 Farmington Ave
General Surgery
Farmington, CT 06030-6227

Phone

(860) 679-8080

Fax

(860) 679-1420

NPI assigned

Dec 30, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• University of Connecticut Health Center

  • Clinical Medical Laboratory
  • Farmington, CT
  • NPI 1427031293
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347321600000",
    "number": "1336126259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060302212",
            "telephone_number": "860-679-7503",
            "fax_number": "860-679-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "address_2": "GENERAL SURGERY",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060306227",
            "telephone_number": "860-679-8080",
            "fax_number": "860-679-1420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KECKLEY",
        "first_name": "W. DALE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-30",
        "last_updated": "2012-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CT",
            "license": "001065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336126259",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paramjeet Kaur, M.D., FACS
• Jeanine Kawi Suchecki, MD
• Reza B. Kazemi, D.M.D.
• Annie D Kearns, WHNP-BC
• Joseph Anthony Kebisek, M.D.
• Robert Daniel Keder, MD
• Grace Kehoe, O.D.
• Mamadi Keita, MD
• George Keithan III, APRN
• Brian Joseph Kelley, M.D.

• Surgical Physician Assistant in Farmington, CT
• Providers in Farmington, CT by specialty
• Surgical Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.