Provider Demographics
NPI:1336179514
Name:KEITZ, SHERI ANN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SHERI
Middle Name:ANN
Last Name:KEITZ
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:
Practice Address - Street 1:67 S BEDFORD ST STE 202E
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-5141
Practice Address - Country:US
Practice Address - Phone:781-744-7000
Practice Address - Fax:781-744-5351
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA258842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG07236Medicare UPIN