Provider Demographics
NPI:1558377408
Name:KELLER, NELSON GEORGE (DPM)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:GEORGE
Last Name:KELLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:730 THIMBLE SHOALS BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4562
Mailing Address - Country:US
Mailing Address - Phone:757-873-1554
Mailing Address - Fax:757-873-3239
Practice Address - Street 1:4030 GEORGE WASHINGTON MEM HWY STE B
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:VA
Practice Address - Zip Code:23692-2619
Practice Address - Country:US
Practice Address - Phone:757-898-5500
Practice Address - Fax:757-898-8001
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0103001053213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1558377408OtherMAMSI
VA1558377408OtherOPTIMA
VA1558377408OtherBLUE CROSS BLUE SHIELD
VA1558377408OtherVIRGINIA HEALTH NETWORK
VA1558377408OtherHUMANA
VA480030191OtherRAILROAD MEDICARE
VA1558377408OtherPHCS
VA1558377408OtherCIGNA
VA1558377408OtherMULTI-PLAN
VA5166525OtherAETNA
VA009300562Medicaid
VA1558377408OtherTRICARE
VA009300562Medicaid