Healthcare Provider Details

I. General information

NPI: 1871279323
Provider Name (Legal Business Name): JOSHUA MCINTOSH KELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MANNING DR CB# 7594
CHAPEL HILL NC
27599-7594
US

IV. Provider business mailing address

170 MANNING DR CB# 7594
CHAPEL HILL NC
27599-7594
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-2011
  • Fax:
Mailing address:
  • Phone: 984-974-2011
  • Fax: 984-974-4721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2026-02236
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: