Provider Demographics
NPI:1376144899
Name:KEYWAN, CHRISTINE (MS)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KEYWAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 D ST UNIT 451
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1284
Mailing Address - Country:US
Mailing Address - Phone:860-307-5504
Mailing Address - Fax:
Practice Address - Street 1:320 D ST UNIT 451
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-1284
Practice Address - Country:US
Practice Address - Phone:860-307-5504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAGC464170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS