Provider Demographics
NPI:1699714451
Name:KEENE, LATAYA A (MD)
Entity type:Individual
Prefix:DR
First Name:LATAYA
Middle Name:A
Last Name:KEENE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:68 S SERVICE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:516-945-3107
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:4320 SEMINARY RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1535
Practice Address - Country:US
Practice Address - Phone:787-363-6163
Practice Address - Fax:757-363-6650
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101240187207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA224858YRNMedicare PIN
VAVV2508AMedicare PIN