Provider Demographics
NPI:1437157054
Name:KELLER, KAREN LASZLO (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LASZLO
Last Name:KELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1750 EL CAMINO REAL
Mailing Address - Street 2:STE 206
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3214
Mailing Address - Country:US
Mailing Address - Phone:650-692-0182
Mailing Address - Fax:650-692-7741
Practice Address - Street 1:1750 EL CAMINO REAL
Practice Address - Street 2:STE 206
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3214
Practice Address - Country:US
Practice Address - Phone:650-692-0182
Practice Address - Fax:650-692-7741
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA67381207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG73073Medicare UPIN
CA00A673810Medicare PIN