MEDICARE: GABRIEL EDUARDO KEOGAN

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	235Z00000X	Speech-Language Pathologist	11868	NC

General Provider Information

NPI Number	:	1235542127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL EDUARDO KEOGAN

Provider Business Mailing Address
First Line	:	4107 PALLADIUM DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-9102
Country	:	US
Telephone Number	:	925-914-9692
Fax Number	:

Provider Business Practice Location Address
First Line	:	4107 PALLADIUM DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-9102
Country	:	US
Telephone Number	:	925-914-9692
Fax Number	:

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

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	04/15/2026

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Directions to “ GABRIEL EDUARDO KEOGAN ” Practice Location

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