Provider Demographics
NPI:1275290165
Name:KEANE, FERGUS (MB BCH BAO)
Entity Type:Individual
Prefix:DR
First Name:FERGUS
Middle Name:
Last Name:KEANE
Suffix:
Gender:M
Credentials:MB BCH BAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 MAIN ST APT 2S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0084
Mailing Address - Country:US
Mailing Address - Phone:191-776-7100
Mailing Address - Fax:
Practice Address - Street 1:MEMORIAL SLOAN KETTERING CANCER CENTER
Practice Address - Street 2:300 E 66TH ST, NEW YORK,
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:212-639-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP111770207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology