Provider Demographics
NPI:1881646933
Name:DANIEL A KEENAN JR MD LLC
Entity Type:Organization
Organization Name:DANIEL A KEENAN JR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, LLC
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:864-225-3316
Mailing Address - Street 1:803 N FANT ST
Mailing Address - Street 2:SUITE 3-B
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5700
Mailing Address - Country:US
Mailing Address - Phone:864-225-3316
Mailing Address - Fax:864-225-3317
Practice Address - Street 1:803 N FANT ST
Practice Address - Street 2:SUITE 3-B
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5700
Practice Address - Country:US
Practice Address - Phone:864-225-3316
Practice Address - Fax:864-225-3317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8491Medicare PIN