MEDICARE: DR. SHENNA R KEENE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101238312	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C06695	OTHER	VA	GROUP PTAN
2	C06115	OTHER	VA	GROUP PTAN

General Provider Information

NPI Number	:	1063407039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHENNA R KEENE MD

Provider Business Mailing Address
First Line	:	14100 AGEE LN
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-4375
Country	:	US
Telephone Number	:	804-379-5343
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 BROAD ROCK BLVD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23249-0001
Country	:	US
Telephone Number	:	804-675-5000
Fax Number	:	804-675-5029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	05/27/2016

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