Basic Information
| Provider Information | |||||||||
| NPI: | 1245201375 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'KEEFFE | ||||||||
| FirstName: | GWENN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 MILK ST | ||||||||
| Address2: | PROVIDER ENROLLMENT - 9TH FLOOR | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021094806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175598053 | ||||||||
| FaxNumber: | 6174213487 | ||||||||
| Practice Location | |||||||||
| Address1: | 228 BILLERICA RD | ||||||||
| Address2: | |||||||||
| City: | CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018243604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782506000 | ||||||||
| FaxNumber: | 9782506460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 205039 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0020248 | 01 | MA | NEIGHBORHOOD HEALTH | OTHER | 0197742 | 05 | MA | MEDICAID | 205039 | 01 | MA | TUFTS | OTHER | AA26004 | 01 | MA | HARVARD PILGRIM | OTHER | J22828 | 01 | MA | BLUE CROSS | OTHER |