Healthcare Provider Details

I. General information

NPI: 1093249351
Provider Name (Legal Business Name): KEELY HARRISON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 MONROE ST
DOVER OH
44622-2046
US

IV. Provider business mailing address

PO BOX 80690
CANTON OH
44708-0690
US

V. Phone/Fax

Practice location:
  • Phone: 330-364-8889
  • Fax: 330-343-7505
Mailing address:
  • Phone: 330-363-7444
  • Fax: 330-363-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.137616
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: