Provider Demographics
NPI:1033118948
Name:NOBIL, KEITH C (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:C
Last Name:NOBIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:148 EAST AVE
Mailing Address - Street 2:SUITE 3H
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5721
Mailing Address - Country:US
Mailing Address - Phone:203-354-6100
Mailing Address - Fax:203-354-6196
Practice Address - Street 1:250 PARADISE RD
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-2948
Practice Address - Country:US
Practice Address - Phone:781-596-2000
Practice Address - Fax:781-595-7111
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA47988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2088401Medicaid
MA2088401Medicaid
MAJ01104Medicare ID - Type Unspecified