Healthcare Provider Details

I. General information

NPI: 1023055712
Provider Name (Legal Business Name): CONSTANCE H KEEFER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115
US

IV. Provider business mailing address

1295 BOYLSTON ST STE 320
BOSTON MA
02215
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-6030
  • Fax: 617-278-6983
Mailing address:
  • Phone: 857-218-4349
  • Fax: 617-730-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33751
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number33751
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: