Provider Demographics
NPI:1700874955
Name:PENNEY, KEITH EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:EDWARD
Last Name:PENNEY
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 1:538 LITCHFIELD ST STE G01
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6669
Mailing Address - Country:US
Mailing Address - Phone:860-496-9877
Mailing Address - Fax:860-496-0441
Practice Address - Street 1:538 LITCHFIELD ST STE G01
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790
Practice Address - Country:US
Practice Address - Phone:860-496-9877
Practice Address - Fax:860-496-0441
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039414207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP2397979OtherOXFORD
CT010039414CT04OtherBLUE CROSS BLUE SHIELD
CT001394147Medicaid
CT7643168006OtherCIGNA
CT2V4410OtherHEALTHNET
3200664OtherAETNA
CT2011881OtherUNITED HEALTHCARE
CT755782OtherCONNECTICARE
CT2V4410OtherHEALTHNET
3200664OtherAETNA