Provider Demographics
NPI:1053516351
Name:KEEGAN, BRIAN ROBERT (MD, PH D)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ROBERT
Last Name:KEEGAN
Suffix:
Gender:M
Credentials:MD, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 ONE MILE RD EXT
Mailing Address - Street 2:SUITE G
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2505
Mailing Address - Country:US
Mailing Address - Phone:609-619-3433
Mailing Address - Fax:609-426-0530
Practice Address - Street 1:59 ONE MILE RD EXT
Practice Address - Street 2:SUITE G
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2505
Practice Address - Country:US
Practice Address - Phone:609-619-3433
Practice Address - Fax:609-426-0530
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08659700207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology