Healthcare Provider Details

I. General information

NPI: 1245196302
Provider Name (Legal Business Name): DANIEL MAX KELLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2026
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 LINCOLN SQ
WORCESTER MA
01608-1135
US

IV. Provider business mailing address

4 FERRY ST
SOUTH GRAFTON MA
01560-1325
US

V. Phone/Fax

Practice location:
  • Phone: 508-373-5607
  • Fax:
Mailing address:
  • Phone: 774-437-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: