Provider Demographics
NPI:1861401085
Name:KEANEY, STEPHANIE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ELIZABETH
Last Name:KEANEY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:67 HALL RD
Practice Address - Street 2:SUITE 3
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1472
Practice Address - Country:US
Practice Address - Phone:508-347-3344
Practice Address - Fax:508-347-7319
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA213987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
213987OtherMASS LIC
J24965OtherBCBS
56039OtherFALLON
7722439OtherAETNA
976466OtherNETWORK HEALTH
712890OtherHARVARD PILGRIM
042103577OtherHEALTH CARE VALUE
MA1346420874OtherHARRINGTON PHYSICIAN SERVICES
042103577OtherHMH TAX ID
213987OtherTUFTS
042103577OtherONE HEALTH
0462357027OtherPAL CIGNA PHYSICAL THERAP
042103577OtherPIONEER
042103577OtherCONSOLIDATED
3984149001OtherCIGNA
042103577OtherPRIVATE HEALTH SYSTEM
042103577OtherMANAGED CARE
MA2165210OtherMASSHEALTH
J24965OtherBCBS
0462357027OtherPAL CIGNA PHYSICAL THERAP
712890OtherHARVARD PILGRIM