Provider Demographics
NPI:1558389395
Name:KELLER, MARLA J (MD)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:J
Last Name:KELLER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3332 ROCHAMBEAU AVE
Mailing Address - Street 2:DEPARTMENT OF MEDICINE, CENTENNIAL BUILDING, 3RD FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2836
Mailing Address - Country:US
Mailing Address - Phone:718-430-3240
Mailing Address - Fax:718-430-8879
Practice Address - Street 1:1300 MORRIS PARK AVE
Practice Address - Street 2:MAZER BUILDING, ROOM 512
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1900
Practice Address - Country:US
Practice Address - Phone:718-430-3240
Practice Address - Fax:718-430-8879
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-04-11
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Provider Licenses
StateLicense IDTaxonomies
NY210007207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
3U5851Medicare ID - Type Unspecified
G84671Medicare UPIN