Individual
MS. ELAINE MARY KEANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
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
Update your record
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