Provider Demographics
NPI:1841219599
Name:KEENHOLTZ, STEVEN LAURENCE (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:LAURENCE
Last Name:KEENHOLTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 COMMONWEALTH AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3629
Mailing Address - Country:US
Mailing Address - Phone:978-777-6544
Mailing Address - Fax:978-774-2091
Practice Address - Street 1:140 COMMONWEALTH AVE
Practice Address - Street 2:STE 104
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3629
Practice Address - Country:US
Practice Address - Phone:978-777-6544
Practice Address - Fax:978-774-2091
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45872207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0122866Medicaid
MAA54724Medicare UPIN
MA0122866Medicaid
MAE05387Medicare PIN