Provider Demographics
NPI:1205867108
Name:STUART, KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:STUART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:SHAPIRO 913D
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-9235
Mailing Address - Fax:617-975-5665
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:SHAPIRO 913D
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-9235
Practice Address - Fax:617-975-5665
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA60230174400000X, 207RX0202X
MA80230207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3076661Medicaid
MAJ10934Medicare PIN