Provider Demographics
NPI:1982608410
Name:KEANE, DANIEL J (DPM)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:KEANE
Suffix:
Gender:M
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:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-3758
Mailing Address - Country:US
Mailing Address - Phone:207-495-3323
Mailing Address - Fax:
Practice Address - Street 1:47 MAIN ST
Practice Address - Street 2:
Practice Address - City:COOPERS MILLS
Practice Address - State:ME
Practice Address - Zip Code:04341-3758
Practice Address - Country:US
Practice Address - Phone:207-549-7581
Practice Address - Fax:937-847-8635
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002572213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0757604Medicaid
OH4237161OtherMEDICARE PTAN
OH4654450001Medicare NSC
OH0757604Medicaid
OH0650732Medicare PIN