Individual
MS. ELAINE MARY KEANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
ONE BAKER PLACE, MINERAL COUNTY BOARD OF EDUCATION, KEYSER, WV 26726
(304) 788-4200
(304) 788-6461
Mailing address
119 N ALLEGANY STREET, CUMBERLAND, MD 21531
(301) 722-5420
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
02018
MD
2083X0100X
Occupational Medicine Physician
Primary
1150
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810001121
—
WV
Enumeration date
01/16/2008
Last updated
01/16/2008
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