Basic Information
Provider Information | |||||||||
NPI: | 1003907098 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KEESEE | ||||||||
FirstName: | SEAN | ||||||||
MiddleName: | T. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7 HOLLAND WAY FL 1 | ||||||||
Address2: |   | ||||||||
City: | EXETER | ||||||||
State: | NH | ||||||||
PostalCode: | 038332997 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6037771096 | ||||||||
FaxNumber: | 6035807210 | ||||||||
Practice Location | |||||||||
Address1: | 5 ALUMNI DR FL 2 | ||||||||
Address2: |   | ||||||||
City: | EXETER | ||||||||
State: | NH | ||||||||
PostalCode: | 038332128 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6035807525 | ||||||||
FaxNumber: | 6035807542 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/27/2006 | ||||||||
LastUpdateDate: | 07/20/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 21815 | WV | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 18838 | NH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 001753005 | 01 | WV | BLUE CROSS BLUE SHEILD | OTHER | 7717666 | 01 | WV | AETNA | OTHER | 3112693 | 05 | NH |   | MEDICAID | 3810002628 | 05 | WV |   | MEDICAID |