MEDICARE: CHARLES H KEENEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	216355	NY

General Provider Information

NPI Number	:	1588643423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES H KEENEN MD

Provider Business Mailing Address
First Line	:	1001 W FAYETTE ST
Second Line	:	STE 400
City	:	SYRACUSE
State	:	NY
Zip	:	13204-2859
Country	:	US
Telephone Number	:	315-472-1488
Fax Number	:	315-472-8060

Provider Business Practice Location Address
First Line	:	37 W GARDEN ST
Second Line	:	SUITE 102
City	:	AUBURN
State	:	NY
Zip	:	13021-2662
Country	:	US
Telephone Number	:	315-282-0525
Fax Number	:	315-282-0526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	05/12/2008

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