Individual
VIVIAN KEENAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
19320 US ROUTE 11, WATERTOWN, NY 13601-5337
(315) 786-0254
Mailing address
19320 US ROUTE 11, WATERTOWN, NY 13601-5337
(315) 786-0254
(315) 785-3647
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
280084
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
280084
MEDICAL LICENSE
NY
Enumeration date
06/06/2012
Last updated
01/12/2021
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