Provider Demographics
NPI:1669526539
Name:KELLER, ALAN S (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:S
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 1:325 CENTRAL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3219
Mailing Address - Country:US
Mailing Address - Phone:610-296-0142
Mailing Address - Fax:610-651-2880
Practice Address - Street 1:325 CENTRAL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3219
Practice Address - Country:US
Practice Address - Phone:610-296-0142
Practice Address - Fax:610-651-2880
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-018947-E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKE107366Medicare ID - Type Unspecified
PAC30313Medicare UPIN