Provider Demographics
NPI:1093261828
Name:KEITH, BRIANNA S
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:S
Last Name:KEITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BOYLSTON ST STE 301
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2008
Mailing Address - Country:US
Mailing Address - Phone:617-731-3400
Mailing Address - Fax:617-566-2224
Practice Address - Street 1:200 BOYLSTON ST STE 301
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2008
Practice Address - Country:US
Practice Address - Phone:617-731-3400
Practice Address - Fax:617-566-2224
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2280009207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6596OtherAPRN LICENSE NUMBER