Provider Demographics
NPI:1790851558
Name:KEATING, ROBERT JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
Last Name:KEATING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18820 BAGLEY RD
Mailing Address - Street 2:#102
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3325
Mailing Address - Country:US
Mailing Address - Phone:440-973-4427
Mailing Address - Fax:440-973-4428
Practice Address - Street 1:18820 BAGLEY RD
Practice Address - Street 2:#102
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3325
Practice Address - Country:US
Practice Address - Phone:440-973-4427
Practice Address - Fax:440-973-4428
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-06-0778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE68496Medicare UPIN
OH4039121Medicare PIN