Provider Demographics
NPI:1386667327
Name:KELLERMAN, BART A (DPM)
Entity Type:Individual
Prefix:
First Name:BART
Middle Name:A
Last Name:KELLERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 ASH STREET
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867
Mailing Address - Country:US
Mailing Address - Phone:781-944-8341
Mailing Address - Fax:781-944-3021
Practice Address - Street 1:161 ASH STREET
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867
Practice Address - Country:US
Practice Address - Phone:781-944-8341
Practice Address - Fax:781-944-3021
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1453213E00000X
NH171213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
708712OtherTUFTS HEALTH CARE
Y70579OtherBLUE CROSS BLUE SHIELD MA
33535OtherHARVARD PILGRIM
0030343OtherNEIGHBORHOOD HEALTH
0030343OtherNEIGHBORHOOD HEALTH
MA1386667327Medicare PIN