Individual
KEITH BOUNDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(774) 442-2173
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
237557
MA
207RI0200X
Infectious Disease Physician
Primary
249958
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110109222A
—
MA
Enumeration date
06/11/2008
Last updated
10/30/2020
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