Healthcare Provider Details

I. General information

NPI: 1104280189
Provider Name (Legal Business Name): KEIRAN WARNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 05/01/2024
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 SPRING ST
WEST ROXBURY MA
02132
US

IV. Provider business mailing address

1400 VFW PKWY
WEST ROXBURY MA
02132-4927
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberA154527
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License NumberA154527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: