Provider Demographics
NPI:1497798466
Name:KELLER, ROBERT B (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:KELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:301 US ROUTE 1
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7609
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:49 SPRING ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8926
Practice Address - Country:US
Practice Address - Phone:207-885-4479
Practice Address - Fax:207-883-2586
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEMD9796207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME283460099Medicaid
NH30225155Medicaid
ME07122402Medicare PIN
ME07122401Medicare PIN
MEP00441383Medicare PIN
MED03792Medicare UPIN
NH30225155Medicaid
ME071224Medicare PIN
ME07122403Medicare PIN