Basic Information
| Provider Information | |||||||||
| NPI: | 1881906147 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEESHAN | ||||||||
| FirstName: | BRITTON | ||||||||
| MiddleName: | CONROY | ||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 PARK STREET | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037854081 | ||||||||
| FaxNumber: | 2037372786 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PARK STREET | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037854081 | ||||||||
| FaxNumber: | 2037372786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2010 | ||||||||
| LastUpdateDate: | 08/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 60793 | CT | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0202X | 60793 | CT | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 1881906147 | 05 | WA | MEDICAID |