Provider Demographics
NPI:1205928876
Name:KELLER, ANDREW J (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 SUNSET LN
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3917
Practice Address - Country:US
Practice Address - Phone:540-829-4100
Practice Address - Fax:540-829-5001
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042235207RC0000X, 207RA0001X
MORF7F81207RC0000X
VA01010462235207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
40159OtherOPTIMUM CHOICE
541977219OtherUNITED HEALTHCARE
0004OtherCAREFIRST
40159OtherMDIPA
060058383OtherRAILROAD MEDICARE
432666OtherANTHEM
958360OtherAETNA HMO
40159OtherALLIANCE GEHA
541977219OtherTRICARE
4120244OtherAETNA PPO MC
432667OtherANTHEM HEALTHKEEPERS PLUS
P00025866OtherRAILROAD MEDICARE
00V370C96OtherMEDICARE OF VA
541977219OtherCIGNA
40159OtherMAMSI
505382OtherNCPPO
541977219OtherNALC AFFORDABLE
541977219OtherTRICARE
541977219OtherCIGNA
VA000Y01C88Medicare ID - Type Unspecified