Provider Demographics
NPI:1508857707
Name:KEILSON, GARY R (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:KEILSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-368-3150
Mailing Address - Fax:508-368-3152
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 230 S
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1312
Practice Address - Country:US
Practice Address - Phone:508-368-3150
Practice Address - Fax:508-368-3152
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2011-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA740842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherONE HEALTH PLAN
5845001OtherAETNA US HEALTHCARE
AA3016OtherHARVARD PILGRIM HEALTHCAR
29203OtherCHILDRENS MEDICAL SECURIT
J14372OtherBLUE CARE ELECT
042472266OtherHEALTHCARE VALUE MANAGEME
9900842OtherFALLON COMMUNITY HEALTH P
J14372OtherBLUE SHIELD HMO BLUE
J14372OtherBLUE INDEMNITY
130015211OtherRAILROAD MEDICARE
J14372OtherMEDICARE B
3118649OtherMEDICAID WELFARE
784035OtherMVP HEALTH CARE
0500193OtherEVERCARE
29203OtherHEALTHY START
042472266OtherPRIVATE HEALTHCARE SYSTEM
1700170OtherCIGNA PAL ID
917831OtherFIRST HEALTH
130015211OtherRAILROAD MEDICARE
917831OtherFIRST HEALTH