Healthcare Provider Details

I. General information

NPI: 1821558230
Provider Name (Legal Business Name): PATRICK RAYMOND KELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N. CAROLINE STREET JHOC 8152C
BALTIMORE MD
21287-0006
US

IV. Provider business mailing address

1 W RIDGEWOOD AVE STE 110
PARAMUS NJ
07652-2361
US

V. Phone/Fax

Practice location:
  • Phone: 518-878-6703
  • Fax:
Mailing address:
  • Phone: 201-444-9522
  • Fax: 201-444-9277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number25MA13004100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: