Provider Demographics
NPI:1225090913
Name:KEAVENY, LORA HABIB (DO)
Entity Type:Individual
Prefix:DR
First Name:LORA
Middle Name:HABIB
Last Name:KEAVENY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 MAIN ST W
Mailing Address - Street 2:SUITE A
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-2943
Mailing Address - Country:US
Mailing Address - Phone:304-465-0544
Mailing Address - Fax:304-465-8832
Practice Address - Street 1:119 MAIN ST W
Practice Address - Street 2:SUITE A
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2943
Practice Address - Country:US
Practice Address - Phone:304-465-0544
Practice Address - Fax:304-465-8832
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0084786001Medicaid
WV0084786001Medicaid
H38779Medicare UPIN