MEDICARE: THERESE MARIE KEELING 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	2084P0800X	Psychiatry Physician	27462	KY
2	2084P0800X	Psychiatry Physician	01043542	IN

General Provider Information

NPI Number	:	1104985605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESE MARIE KEELING MD

Provider Business Mailing Address
First Line	:	4925 CHARLESTOWN RD
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-9426
Country	:	US
Telephone Number	:	812-941-9200
Fax Number	:	812-941-9205

Provider Business Practice Location Address
First Line	:	4925 CHARLESTOWN RD
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-9426
Country	:	US
Telephone Number	:	812-941-9200
Fax Number	:	812-941-9205

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	09/03/2014

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