Provider Demographics
NPI:1811080013
Name:KEOUGH, WILLIAM LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LAWRENCE
Last Name:KEOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 MUIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15229-2928
Mailing Address - Country:US
Mailing Address - Phone:717-657-1957
Mailing Address - Fax:
Practice Address - Street 1:529 MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02129-1122
Practice Address - Country:US
Practice Address - Phone:857-301-0143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA289808208000000X
PAMD417522208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2750661Medicaid
WV38100091110Medicaid
PA1019202420001Medicaid
PA111798PC1Medicare PIN
OH2750661Medicaid