Healthcare Provider Details

I. General information

NPI: 1144202565
Provider Name (Legal Business Name): CHRISTOPHER P KEUKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2005
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N DEPARTMENT OF PEDIATRIC HEMATOLOGY/ONCOLOGY
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-0001
US

V. Phone/Fax

Practice location:
  • Phone: 508-856-4225
  • Fax: 774-441-8057
Mailing address:
  • Phone: 800-225-8885
  • Fax: 508-334-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number209576
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: