Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 209576 | MA |
NPI | 1144202565 |
---|---|
Provider Name | Dr. Christopher P Keuker |
First Address | Boston, MA 02241-0001 |
Second Address | Worcester, MA 01655-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2005 |
Last Update Date | 21/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110004919A | (05) | MA |
G65105 | (02) | MA |