Provider Demographics
NPI:1043302482
Name:KEIRAN, MARGARET R (NP)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:R
Last Name:KEIRAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:R
Other - Last Name:PAUSTIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 DAVOL SQ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4754
Mailing Address - Country:US
Mailing Address - Phone:401-421-4000
Mailing Address - Fax:401-272-1456
Practice Address - Street 1:850 AQUIDNECK AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-7280
Practice Address - Country:US
Practice Address - Phone:401-846-0055
Practice Address - Fax:401-842-0963
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00676363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW05-0483739OtherTAX ID #
RI1043302482Medicaid
RI709004149OtherMEDICARE GROUP PTAN
RIU400254832Medicare PIN
RI1043302482Medicaid