Provider Demographics
NPI:1154570844
Name:KEELEY, BROOKE (DPM)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:
Last Name:KEELEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 KINGSTOWN RD STE 106
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3239
Mailing Address - Country:US
Mailing Address - Phone:484-885-8702
Mailing Address - Fax:
Practice Address - Street 1:360 KINGSTOWN RD
Practice Address - Street 2:SUITE 106
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3239
Practice Address - Country:US
Practice Address - Phone:401-782-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2012-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1229213ES0103X
RIDPM00333213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1154570844Medicare NSC