Provider Demographics
NPI:1750360681
Name:GONZALEZ-KEELAN, CARMEN I (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:I
Last Name:GONZALEZ-KEELAN
Suffix:
Gender:F
Credentials:MD
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 365067
Mailing Address - Street 2:DEPARTAMENTO DE PATOLOGIA RCM
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-5067
Mailing Address - Country:US
Mailing Address - Phone:787-758-2525
Mailing Address - Fax:787-754-0710
Practice Address - Street 1:PATOLOGIA RCM - UPR
Practice Address - Street 2:APARTADO 29134
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00929-0134
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:787-754-0710
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6705207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0098577Medicare PIN
PRD-26721Medicare UPIN
PR28076IMedicare ID - Type Unspecified