Healthcare Provider Details

I. General information

NPI: 1811080013
Provider Name (Legal Business Name): WILLIAM LAWRENCE KEOUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MAIN ST STE 500
BOSTON MA
02129-1122
US

IV. Provider business mailing address

136 MUIRFIELD DR
PITTSBURGH PA
15229-2928
US

V. Phone/Fax

Practice location:
  • Phone: 857-301-0143
  • Fax:
Mailing address:
  • Phone: 717-657-1957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number289808
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD417522
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: