Healthcare Provider Details

I. General information

NPI: 1366426348
Provider Name (Legal Business Name): DR. PAUL W KEOUGH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 WEBSTER ST
HANOVER MA
02339-1200
US

IV. Provider business mailing address

15 WOODBRIDGE RD
HINGHAM MA
02043-3144
US

V. Phone/Fax

Practice location:
  • Phone: 781-878-7020
  • Fax: 781-871-3590
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number54115
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: