Provider Demographics
NPI:1417428848
Name:DAVID D KELLER DO PC
Entity Type:Organization
Organization Name:DAVID D KELLER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-347-3164
Mailing Address - Street 1:195 FORE RIVER PKWY STE 470
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2787
Mailing Address - Country:US
Mailing Address - Phone:207-347-3164
Mailing Address - Fax:207-899-3195
Practice Address - Street 1:195 FORE RIVER PKWY STE 470
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2787
Practice Address - Country:US
Practice Address - Phone:207-347-3164
Practice Address - Fax:207-899-3195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty