Provider Demographics
NPI:1750355046
Name:KEENAN, DONALD M
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:M
Last Name:KEENAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1006
Mailing Address - Country:US
Mailing Address - Phone:233-048-0591
Mailing Address - Fax:330-480-3486
Practice Address - Street 1:1044 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1006
Practice Address - Country:US
Practice Address - Phone:233-048-0591
Practice Address - Fax:330-480-3486
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.061950208600000X
PAMD065330L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2064555Medicaid
PA001706150Medicaid
OH2064555Medicaid
012950Medicare PIN
PA0017061500005Medicaid