Individual
DR. KEITH AUSTIN MARILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2696
(617) 643-8595
(617) 724-0917
Mailing address
55 FRUIT ST, BOSTON, MA 02114-2696
(617) 643-8595
(617) 724-0917
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
214889
MA
207P00000X
Emergency Medicine Physician
Primary
MD448123
PA
207R00000X
Internal Medicine Physician
214889
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0199010
—
MA
01
—
451736
TUFTS HEALTH PLAN
MA
01
—
J24824
BCBS MA
MA
Enumeration date
10/27/2005
Last updated
05/24/2019
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