Healthcare Provider Details

I. General information

NPI: 1710056007
Provider Name (Legal Business Name): ROBERT THOMAS KEENAN M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CHEVES ST STE 280
FLORENCE SC
29506-2652
US

IV. Provider business mailing address

800 E CHEVES ST STE 280
FLORENCE SC
29506-2652
US

V. Phone/Fax

Practice location:
  • Phone: 843-973-8770
  • Fax: 843-428-2490
Mailing address:
  • Phone: 843-973-8770
  • Fax: 843-428-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2009-00743
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number245668
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number245668
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number84334
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: