Provider Demographics
NPI:1306832068
Name:WELKER, KEITH B (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:B
Last Name:WELKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E BRADY ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4648
Mailing Address - Country:US
Mailing Address - Phone:724-282-1737
Mailing Address - Fax:724-282-2288
Practice Address - Street 1:901 E BRADY ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4648
Practice Address - Country:US
Practice Address - Phone:724-282-1737
Practice Address - Fax:724-282-2288
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-07-14
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-06-28
Provider Licenses
StateLicense IDTaxonomies
PAMD043242L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012402710001Medicaid
PA0012402710001Medicaid
PAE73666Medicare UPIN