Provider Demographics
NPI:1073587515
Name:KELLER, THOMAS C JR (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:KELLER
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:250 FAME AVE
Mailing Address - Street 2:SUITE 135
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1587
Mailing Address - Country:US
Mailing Address - Phone:717-632-3235
Mailing Address - Fax:717-632-7292
Practice Address - Street 1:250 FAME AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1587
Practice Address - Country:US
Practice Address - Phone:717-632-3235
Practice Address - Fax:717-632-7292
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2010-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS013037207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010925380001Medicaid
PA081623RP9Medicare ID - Type Unspecified
PAI12535Medicare UPIN