Provider Demographics
NPI:1609847524
Name:KEATING, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:KEATING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 911
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302
Mailing Address - Country:US
Mailing Address - Phone:207-396-7600
Mailing Address - Fax:207-396-7986
Practice Address - Street 1:81 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 1300
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-729-1148
Practice Address - Fax:207-729-2789
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME11930207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM113101Medicare PIN
MEP00445881Medicare PIN
MEMM1131Medicare PIN
B86917Medicare UPIN