MEDICARE: MATTHEW KELLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD422880	PA

General Provider Information

NPI Number	:	1144266412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW KELLER

Provider Business Mailing Address
First Line	:	5404 BEACON ST
Second Line	:	CORPORATE ONE OFFICE PARK, BUILD ONE
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-1902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4262 OLD WILLIAM PENN HWY
Second Line	:	SUITE 208
City	:	MURRYSVILLE
State	:	PA
Zip	:	15668-1953
Country	:	US
Telephone Number	:	724-325-2133
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	03/25/2021

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