Provider Demographics
NPI:1801926829
Name:KELLER, MARTIN BARRY (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:BARRY
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 1:381 CONANT RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1763
Mailing Address - Country:US
Mailing Address - Phone:781-373-5895
Mailing Address - Fax:401-455-6430
Practice Address - Street 1:381 CONANT RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1763
Practice Address - Country:US
Practice Address - Phone:401-455-6430
Practice Address - Fax:401-455-6441
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA360122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry