Provider Demographics
NPI:1942286729
Name:KEOUGH, GEORGE C (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:C
Last Name:KEOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:14490 OCEAN HWY
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-4821
Practice Address - Country:US
Practice Address - Phone:843-881-4440
Practice Address - Fax:843-314-0785
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000035098207N00000X, 207NS0135X
SC93326207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4145097OtherBLUE CROSS BLUE SHIELD
TN3862971Medicaid
TN7527158OtherAETNA
TN7527158OtherAETNA
TN3376258Medicaid