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NPI Code Detail

MEDICARE: JEROME KEEFER ELLIS MD

MEDICARE: JEROME KEEFER ELLIS MD
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
1207R00000XInternal Medicine PhysicianMD069228LPA
2208000000XPediatrics PhysicianMD069228LPA

General Provider Information

NPI Number : 1568423366
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEROME KEEFER ELLIS MD
Provider Business Mailing Address
First Line : 24 CREE DR
Second Line :
City : LOCK HAVEN
State : PA
Zip : 17745-2639
Country : US
Telephone Number : 570-893-5000
Fax Number :
Provider Business Practice Location Address
First Line : 24 CREE DR
Second Line :
City : LOCK HAVEN
State : PA
Zip : 17745-2639
Country : US
Telephone Number : 570-893-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2006
Last Update Date : 09/11/2025

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Directions to “ JEROME KEEFER ELLIS MD” Practice Location

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