Provider Demographics
NPI:1194716290
Name:KIEFF, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:KIEFF
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 1:65 WALNUT STREET
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2184
Mailing Address - Country:US
Mailing Address - Phone:617-997-2900
Mailing Address - Fax:781-489-3380
Practice Address - Street 1:65 WALNUT ST STE 320
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2184
Practice Address - Country:US
Practice Address - Phone:617-997-2900
Practice Address - Fax:781-489-3380
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80006207Y00000X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3179770Medicaid
MAA28561Medicare ID - Type Unspecified
MA3179770Medicaid