Provider Demographics
NPI:1932392628
Name:KELLER, NORMAN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:
Last Name:KELLER
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 GLEN COVE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4235
Mailing Address - Country:US
Mailing Address - Phone:207-921-5737
Mailing Address - Fax:207-921-5333
Practice Address - Street 1:4 GLEN COVE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4235
Practice Address - Country:US
Practice Address - Phone:207-921-5737
Practice Address - Fax:207-921-5333
Is Sole Proprietor?:No
Enumeration Date:2007-08-25
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPA1425363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical