MEDICARE: MARLA J KELLER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	210007	NY

General Provider Information

NPI Number	:	1558389395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLA J KELLER MD

Provider Business Mailing Address
First Line	:	3332 ROCHAMBEAU AVE
Second Line	:	DEPARTMENT OF MEDICINE, CENTENNIAL BUILDING, 3RD FLOOR
City	:	BRONX
State	:	NY
Zip	:	10467-2836
Country	:	US
Telephone Number	:	718-430-3240
Fax Number	:	718-430-8879

Provider Business Practice Location Address
First Line	:	1300 MORRIS PARK AVE
Second Line	:	MAZER BUILDING, ROOM 512
City	:	BRONX
State	:	NY
Zip	:	10461-1900
Country	:	US
Telephone Number	:	718-430-3240
Fax Number	:	718-430-8879

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	04/11/2012

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