Provider Demographics
NPI:1821558230
Name:KELLER, PATRICK RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:RAYMOND
Last Name:KELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 CHARLOTTE AVE APT 542
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4140
Mailing Address - Country:US
Mailing Address - Phone:518-878-6703
Mailing Address - Fax:
Practice Address - Street 1:601 N. CAROLINE STREET
Practice Address - Street 2:JHOC 8152C
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0006
Practice Address - Country:US
Practice Address - Phone:518-878-6703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program