Provider Demographics
NPI:1245201375
Name:O'KEEFFE, GWENN S (MD)
Entity Type:Individual
Prefix:
First Name:GWENN
Middle Name:S
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 1:41 DEER PATH
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-2639
Mailing Address - Country:US
Mailing Address - Phone:617-803-0709
Mailing Address - Fax:
Practice Address - Street 1:10 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4435
Practice Address - Country:US
Practice Address - Phone:085-754-4200
Practice Address - Fax:978-250-6460
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205039208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ22828OtherBLUE CROSS
MA205039OtherTUFTS
MAAA26004OtherHARVARD PILGRIM
MA0197742Medicaid
MA0020248OtherNEIGHBORHOOD HEALTH
MA0197742Medicaid
MAAA26004OtherHARVARD PILGRIM