Healthcare Provider Details

I. General information

NPI: 1265492847
Provider Name (Legal Business Name): JOHN KEANE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

91 STILES RD ATTN: SHARON SILVA
SALEM NH
03079-5804
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-9793
  • Fax:
Mailing address:
  • Phone: 603-890-4404
  • Fax: 603-893-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35177
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: