Provider Demographics
NPI:1023012788
Name:O'KEEFFE, KATHRYN (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:O'KEEFFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HUDSON AVE
Mailing Address - Street 2:PO BOX 144
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4313
Mailing Address - Country:US
Mailing Address - Phone:518-793-4477
Mailing Address - Fax:
Practice Address - Street 1:45 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4313
Practice Address - Country:US
Practice Address - Phone:518-793-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153617-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY160012993OtherRAILROAD MEDICARE
NY000496210002OtherBLUE SHIELD
NY00785511Medicaid
NY15166OtherMVP
NY35F881OtherBLUE CROSS
NY040426007605OtherFIDELIS
NY10002780OtherCDPHP
NY00785511Medicaid