Healthcare Provider Details
I. General information
NPI: 1417931569
Provider Name (Legal Business Name): PETER M KEEFE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 12/02/2005
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
385 SOUTHBRIDGE ST
AUBURN MA
01501-2498
US
IV. Provider business mailing address
5 NEPONSET ST FL STREET2
WORCESTER MA
01606-2714
US
V. Phone/Fax
- Phone: 508-832-5917
- Fax: 508-832-5751
- Phone: 508-832-5917
- Fax: 508-832-5751
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | 74156 |
| License Number State | MA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 917826 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | FIRST HEALTH |
| # 2 | |
| Identifier | J12537 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | BLUE SHIELD HMO BLUE |
| # 3 | |
| Identifier | J12537 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MEDICARE B |
| # 4 | |
| Identifier | 042472266 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | PRIVATE HEALTHCARE SYSTEM |
| # 5 | |
| Identifier | J12537 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | BLUE SHIELD INDEMNITY |
| # 6 | |
| Identifier | 29198 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CHILDRENS MEDICAL SECURIT |
| # 7 | |
| Identifier | 740020 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | TUFTS HEALTH PLAN |
| # 8 | |
| Identifier | AA1174 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HARVARD PILGRIM HEALTHCAR |
| # 9 | |
| Identifier | 29198 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HEALTHY START |
| # 10 | |
| Identifier | J12537 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | BLUE CARE ELECT |
| # 11 | |
| Identifier | 784150 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MVP HEALTH CARE |
| # 12 | |
| Identifier | 9900829 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | FALLON COMMUNITY HEALTH P |
| # 13 | |
| Identifier | 042472266 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | ONE HEALTH PLAN |
| # 14 | |
| Identifier | 042472266 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | THREE RIVERS |
| # 15 | |
| Identifier | 042472266 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | TRICARE CHAMPUS |
| # 16 | |
| Identifier | 7538260 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CIGNA |
| # 17 | |
| Identifier | 042472266 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HEALTHCARE VALUE MANAGEME |
| # 18 | |
| Identifier | 7157271 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AETNA US HEALTHCARE |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
