Provider Demographics
NPI:1063468981
Name:AL-HOJERRY, KEENAN (MD)
Entity Type:Individual
Prefix:
First Name:KEENAN
Middle Name:
Last Name:AL-HOJERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 LAFAYETTE RD BLDG E
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5455
Mailing Address - Country:US
Mailing Address - Phone:603-433-8488
Mailing Address - Fax:603-373-6009
Practice Address - Street 1:278 LAFAYETTE RD BLDG E
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5455
Practice Address - Country:US
Practice Address - Phone:603-433-8488
Practice Address - Fax:603-373-6009
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9576208M00000X
NH9578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2150395Medicaid
ME215930099Medicaid
NH30200657Medicaid
NH30200657Medicaid
ME215930099Medicaid
NHRE406201Medicare PIN