Provider Demographics
NPI:1861438442
Name:KEENAN, JOHN P (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:KEENAN
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 1:83 HERRICK STREET
Mailing Address - Street 2:SUITE 2004
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-927-4800
Mailing Address - Fax:978-232-5772
Practice Address - Street 1:83 HERRICK STREET
Practice Address - Street 2:SUITE 2004
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-927-4800
Practice Address - Fax:978-232-5772
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41197207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
041197OtherTUFTS HEALTH INS
13219OtherHARVARD PILGREM
MA2054191Medicaid
MAD05056Medicare ID - Type Unspecified
MA2054191Medicaid