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General NPI Number Information
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NPI Number | 1316933914
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Entity Type | Individual
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Provider Name | DAVID JAY KELLER M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 44 BIRCH ST SUITE 200
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City | DERRY
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State | NH
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Zip | 03038-2752
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Country | US
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Telephone | 603-421-9130
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Fax | 603-421-2451
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Provider Business Mailing Address
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Address Line | 3 ALBERT CREE DR
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City | RUTLAND
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State | VT
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Zip | 05701-4601
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Country | US
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Telephone | 802-775-2937
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Fax | 802-773-0934
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0420005877
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | LT-2804
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License Number State | NH
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