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 1:910 BOSTON TPKE STE 3
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3396
Practice Address - Country:US
Practice Address - Phone:617-966-1260
Practice Address - Fax:617-762-1278
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205039208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0197742Medicaid
MA205039OtherTUFTS
MAJ22828OtherBLUE CROSS
MAAA26004OtherHARVARD PILGRIM
MA0020248OtherNEIGHBORHOOD HEALTH
MA0197742Medicaid
MAAA26004OtherHARVARD PILGRIM