Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 241741 | MA |
N | 111NI0900X | Internist | 241741 | MA |
N | 207RH0000X | Hematologist | 241741 | IL |
Y | 207RH0003X | Hematology & Oncology | 293945-1 | NY |
N | 207RX0202X | Medical Oncology | 241741 | IL |
NPI | 1235368168 |
---|---|
Provider Name | Dr. Gottfried Raffael Von Keudell |
First Address | New York, NY 10065-6007 |
Second Address | New York, NY 10065-6007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2009 |
Last Update Date | 28/03/2019 |