Basic Information
Provider Information
NPI: 1710410725
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KEELING
FirstName: LAURA
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3600 FORBES AVENUE
Address2: FORBES TOWER- PLAZA LEVEL SUITE 140
City: PI
State: PA
PostalCode: 15213
CountryCode: US
TelephoneNumber: 2024448766
FaxNumber: 2024440272
Practice Location
Address1: UPMC FREDDIE FU SPORTS MEDICINE CENTER
Address2: 3200 SOUTH WATER STREET
City: P
State: PA
PostalCode: 15203
CountryCode: US
TelephoneNumber: 8559377678
FaxNumber: 2024440272
Other Information
ProviderEnumerationDate: 04/06/2017
LastUpdateDate: 03/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/21/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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