Provider Demographics
NPI:1497976112
Name:KELLER, NOAH LAMOND (DO)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:LAMOND
Last Name:KELLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10119 EASTERDAY CT
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-9791
Mailing Address - Country:US
Mailing Address - Phone:716-725-8132
Mailing Address - Fax:716-725-8132
Practice Address - Street 1:WASHINGTON COUNTY HOSPITAL
Practice Address - Street 2:251 EAST ANTIETAM STREET
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5771
Practice Address - Country:US
Practice Address - Phone:301-790-8372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0065688207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412801000Medicaid
MD451601000Medicaid
MDP00433451OtherRAILROAD
MD613LQ952Medicare PIN
MDP00639668Medicare PIN
MDQ952Medicare PIN
MD132611Y1ZMedicare PIN