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General NPI Number Information
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NPI Number | 1699828566
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Entity Type | Individual
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Provider Name | KEITH MEDEIROS M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 157 UNION ST
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City | MARLBOROUGH
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State | MA
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Zip | 01752-1228
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Country | US
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Telephone | 508-624-9687
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Fax | 508-624-9689
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Provider Business Mailing Address
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Address Line | PO BOX 415348
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City | BOSTON
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State | MA
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Zip | 02241-5348
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | 240000
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 240000
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License Number State | MA
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