Provider Demographics
NPI:1861401085
Name:KEANEY, STEPHANIE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ELIZABETH
Last Name:KEANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 HALL RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1472
Mailing Address - Country:US
Mailing Address - Phone:508-347-3344
Mailing Address - Fax:508-347-7319
Practice Address - Street 1:67 HALL RD
Practice Address - Street 2:SUITE 3
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1472
Practice Address - Country:US
Practice Address - Phone:508-347-3344
Practice Address - Fax:508-347-7319
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
042103577OtherHMH TAX ID
712890OtherHARVARD PILGRIM
976466OtherNETWORK HEALTH
042103577OtherPIONEER
0462357027OtherPAL CIGNA PHYSICAL THERAP
3984149001OtherCIGNA
7722439OtherAETNA
042103577OtherCONSOLIDATED
MA1346420874OtherHARRINGTON PHYSICIAN SERVICES
213987OtherMASS LIC
042103577OtherONE HEALTH
MA2165210OtherMASSHEALTH
042103577OtherPRIVATE HEALTH SYSTEM
042103577OtherHEALTH CARE VALUE
042103577OtherMANAGED CARE
213987OtherTUFTS
56039OtherFALLON
J24965OtherBCBS
J24965OtherBCBS
0462357027OtherPAL CIGNA PHYSICAL THERAP
712890OtherHARVARD PILGRIM