Provider Demographics
NPI:1588763353
Name:KEANE, ELIZABETH M (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:KEANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:143 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONT VERNON
Mailing Address - State:NH
Mailing Address - Zip Code:03057
Mailing Address - Country:US
Mailing Address - Phone:603-663-8060
Mailing Address - Fax:
Practice Address - Street 1:145 HOLLIS STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1235
Practice Address - Country:US
Practice Address - Phone:603-626-9500
Practice Address - Fax:606-626-0899
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH9043208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010399Medicaid