Provider Demographics
NPI:1073610267
Name:KEENAN, MALLADI & O'NEILL, P.C.
Entity Type:Organization
Organization Name:KEENAN, MALLADI & O'NEILL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:R GOPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-536-2978
Mailing Address - Street 1:10 HOSPITAL DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-6603
Mailing Address - Country:US
Mailing Address - Phone:413-536-2978
Mailing Address - Fax:413-536-7195
Practice Address - Street 1:10 HOSPITAL DR
Practice Address - Street 2:SUITE 106
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-6603
Practice Address - Country:US
Practice Address - Phone:413-536-2978
Practice Address - Fax:413-536-7195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM13249Medicare ID - Type Unspecified