Provider Demographics
NPI:1942247028
Name:KEULER, MARC M (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:M
Last Name:KEULER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:206 E BROWN ST
Mailing Address - Street 2:POCONO HEALTHCARE MANAGEMENT
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-476-3507
Mailing Address - Fax:570-476-3754
Practice Address - Street 1:100 COMMUNITY DR
Practice Address - Street 2:PMC PHYSICIAN ASSOC .- INTERNAL MEDICINE. SUITE 203
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18466-8985
Practice Address - Country:US
Practice Address - Phone:570-839-8754
Practice Address - Fax:570-839-0893
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD030118E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016390580001Medicaid
PAB40280Medicare UPIN
PA159861PZPMedicare PIN