MEDICARE: MARSHALL KELTNER M.D.

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	207V00000X	Obstetrics & Gynecology Physician	ME109823	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598746034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHALL KELTNER M.D.

Provider Business Mailing Address
First Line	:	1900 E BAY DR
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33771-2218
Country	:	US
Telephone Number	:	727-216-1420
Fax Number	:	727-216-1418

Provider Business Practice Location Address
First Line	:	1900 E BAY DR
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33771-2218
Country	:	US
Telephone Number	:	727-216-1420
Fax Number	:	727-216-1418

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	09/07/2023

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