Provider Demographics
NPI:1164508339
Name:KELLER, ROBERT A (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:KELLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PINE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332
Mailing Address - Country:US
Mailing Address - Phone:781-934-6735
Mailing Address - Fax:
Practice Address - Street 1:349 N MAIN ST
Practice Address - Street 2:CATARACT LASER CENTER
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810
Practice Address - Country:US
Practice Address - Phone:978-475-0959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN126906367500000X
MAAANA28842367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NA0058Medicare ID - Type Unspecified