Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 75852 | MA |
Y | 2080P0204X | Pediatric Emergency Doctor | 75852 | MA |
NPI | 1316921711 |
---|---|
Provider Name | Eileen A Keneck |
First Address | Boston, MA 02118-2371 |
Second Address | Boston, MA 02118-2905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 03/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110051833A | (05) | MA |