Healthcare Provider Details

I. General information

NPI: 1922324078
Provider Name (Legal Business Name): BRIAN HART KEOGH JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 EMERALD PL STE 201
GREENVILLE NC
27834-5743
US

IV. Provider business mailing address

2430 EMERALD PL STE 201
GREENVILLE NC
27834-5743
US

V. Phone/Fax

Practice location:
  • Phone: 252-752-2140
  • Fax: 252-565-8463
Mailing address:
  • Phone: 252-752-2140
  • Fax: 252-565-8463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number2018-00941
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberDR0054763
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: