Healthcare Provider Details

I. General information

NPI: 1316933914
Provider Name (Legal Business Name): DAVID JAY KELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 BIRCH ST SUITE 200
DERRY NH
03038-2752
US

IV. Provider business mailing address

3 ALBERT CREE DR
RUTLAND VT
05701-4601
US

V. Phone/Fax

Practice location:
  • Phone: 603-421-9130
  • Fax: 603-421-2451
Mailing address:
  • Phone: 802-775-2937
  • Fax: 802-773-0934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0420005877
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberLT-2804
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: