Provider Demographics
NPI:1740392885
Name:KELLER, ARLENE (MD)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WEBSTER ST STE 423
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2380
Mailing Address - Country:US
Mailing Address - Phone:415-923-3179
Mailing Address - Fax:415-563-4687
Practice Address - Street 1:2100 WEBSTER ST STE 423
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2380
Practice Address - Country:US
Practice Address - Phone:415-923-3179
Practice Address - Fax:415-563-4687
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65574207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG65574OtherSTATE LICENSE NUMBER
CAF11605Medicare UPIN
CAG65574OtherSTATE LICENSE NUMBER