Provider Demographics
NPI:1902945082
Name:KEENE, WENDY H (PA-C)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:H
Last Name:KEENE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:515 FAIRMOUNT AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5466
Mailing Address - Country:US
Mailing Address - Phone:410-494-1324
Mailing Address - Fax:410-494-1361
Practice Address - Street 1:750 MAIN ST
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-2515
Practice Address - Country:US
Practice Address - Phone:410-526-7800
Practice Address - Fax:410-584-1887
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003038363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCN6601OtherR/R MEDICARE GROUP
MDP00681528OtherR/R MEDICARE PIN
MDQ64574Medicare UPIN
MDP00681528OtherR/R MEDICARE PIN