Provider Demographics
NPI:1598733818
Name:KELLER, RONALD EDWARD (CRNA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:EDWARD
Last Name:KELLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4135 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9803
Mailing Address - Country:US
Mailing Address - Phone:330-286-5330
Mailing Address - Fax:330-286-5396
Practice Address - Street 1:1307 FEDERAL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:412-231-6550
Practice Address - Fax:412-231-6697
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN316539L367500000X
OHRN308280COA1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKE1756956OtherHIGHMARK BCBS
OHP01321181OtherMEDICARE RAILROAD
PA101457049Medicaid
OH8241401OtherMEDICARE PTAN
OH2442182Medicaid
PAP00401820OtherMEDICARE RAILROAD
OHH172870OtherMEDICARE PTAN
OH000000547845OtherANTHEM BCBS
OH2442182Medicaid