Provider Demographics
NPI:1518950666
Name:ROBERT F KELLIHER MD
Entity Type:Organization
Organization Name:ROBERT F KELLIHER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:KELLIHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-668-4555
Mailing Address - Street 1:844 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2954
Mailing Address - Country:US
Mailing Address - Phone:508-668-4555
Mailing Address - Fax:508-668-9062
Practice Address - Street 1:844 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2954
Practice Address - Country:US
Practice Address - Phone:508-668-4555
Practice Address - Fax:508-668-9062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21238Medicare PIN