Provider Demographics
NPI:1528398153
Name:DEVINE, JOAN KEEGAN (DO)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:KEEGAN
Last Name:DEVINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:LANKENAU MEDICAL CENTER, MOB-EAST, SUITE 158
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-649-2126
Mailing Address - Fax:610-642-7814
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:LANKENAU MEDICAL CENTER, MOB-EAST, SUITE 158
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-649-2126
Practice Address - Fax:610-642-7814
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOSO14347207V00000X
PAFD3534927207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology