Provider Demographics
NPI:1285746883
Name:KEENAN, JOEL WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:WILLIAM
Last Name:KEENAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 BRICKYARD LN
Mailing Address - Street 2:SUITE CC
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909
Mailing Address - Country:US
Mailing Address - Phone:207-361-4902
Mailing Address - Fax:207-363-2505
Practice Address - Street 1:1 BRICKYARD LN
Practice Address - Street 2:SUITE CC
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909
Practice Address - Country:US
Practice Address - Phone:207-361-4902
Practice Address - Fax:207-363-2505
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME016460207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431948300Medicaid
ME431948300Medicaid
MEME1544Medicare PIN