Healthcare Provider Details

I. General information

NPI: 1184244592
Provider Name (Legal Business Name): HENRY TAIT KEENAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2020
Last Update Date: 10/03/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. NAVAL HOSPITAL GUAM BLDG 50, FARENHOLT AVENUE
AGANA HEIGHTS GU
96910
US

IV. Provider business mailing address

BLDG 50, FARENHOLT AVE
AGANA HEUGHTS GU
96910
US

V. Phone/Fax

Practice location:
  • Phone: 671-344-9340
  • Fax:
Mailing address:
  • Phone: 671-344-9340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101273456
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: