MEDICARE: NELSON GEORGE KELLER DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	0103001053	VA
2	213E00000X	Podiatrist	0103001053	VA
3	213EP1101X	Primary Podiatric Medicine Podiatrist	0103001053	VA
4	213ES0131X	Foot Surgery Podiatrist	0103001053	VA
5	213ES0000X	Sports Medicine Podiatrist	0103001053	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	480030191	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1558377408	OTHER	VA	MAMSI
2	1558377408	OTHER	VA	OPTIMA
3	1558377408	OTHER	VA	BLUE CROSS BLUE SHIELD
4	1558377408	OTHER	VA	VIRGINIA HEALTH NETWORK
5	1558377408	OTHER	VA	HUMANA
7	1558377408	OTHER	VA	PHCS
8	1558377408	OTHER	VA	CIGNA
9	1558377408	OTHER	VA	MULTI-PLAN
10	5166525	OTHER	VA	AETNA
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	1558377408	OTHER	VA	TRICARE

General Provider Information

NPI Number	:	1558377408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELSON GEORGE KELLER DPM

Provider Business Mailing Address
First Line	:	730 THIMBLE SHOALS BLVD STE 130
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-4562
Country	:	US
Telephone Number	:	757-873-1554
Fax Number	:	757-873-3239

Provider Business Practice Location Address
First Line	:	4030 GEORGE WASHINGTON MEM HWY STE B
Second Line	:
City	:	GRAFTON
State	:	VA
Zip	:	23692-2619
Country	:	US
Telephone Number	:	757-898-5500
Fax Number	:	757-898-8001

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	02/16/2026

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Directions to “ NELSON GEORGE KELLER DPM” Practice Location

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