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General NPI Number Information
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NPI Number | 1699714451
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Entity Type | Individual
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Provider Name | LATAYA A KEENE MD
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Gender | Female
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 4320 SEMINARY RD
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City | ALEXANDRIA
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State | VA
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Zip | 22304-1535
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Country | US
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Telephone | 787-363-6163
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Fax | 757-363-6650
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Provider Business Mailing Address
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Address Line | 68 S SERVICE RD SUITE 350
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City | MELVILLE
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State | NY
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Zip | 11747
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Country | US
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Telephone | 516-945-3107
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Fax | 516-945-3131
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0101240187
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License Number State | VA
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