Provider Demographics
NPI:1386129468
Name:BOUTHILLER, KERI SUSAN (RT(R)CT)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:SUSAN
Last Name:BOUTHILLER
Suffix:
Gender:F
Credentials:RT(R)CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1806
Mailing Address - Country:US
Mailing Address - Phone:781-521-5584
Mailing Address - Fax:
Practice Address - Street 1:9 STEVENS ST
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1806
Practice Address - Country:US
Practice Address - Phone:781-521-5584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2878432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology