Provider Demographics
NPI:1962493478
Name:DREYER, KEITH JAY (DO PHD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:JAY
Last Name:DREYER
Suffix:
Gender:M
Credentials:DO PHD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:E00 3E RADIOLOGICAL ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-1962
Practice Address - Fax:617-724-5597
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2012-07-26
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Provider Licenses
StateLicense IDTaxonomies
MA797532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ30723OtherBCBS MA
MA750053OtherTUFTS HEALTH PLAN
MA3128504Medicaid
MA750053OtherTUFTS HEALTH PLAN
F83352Medicare UPIN