Provider Demographics
NPI:1336134063
Name:KEANE, TIMOTHY E (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:KEANE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BURCHMYER DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1709
Mailing Address - Country:US
Mailing Address - Phone:843-524-1078
Mailing Address - Fax:843-524-1137
Practice Address - Street 1:2403 ALLISON RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5923
Practice Address - Country:US
Practice Address - Phone:843-524-1078
Practice Address - Fax:843-524-1137
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC02240208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF76135Medicare UPIN