Provider Demographics
NPI:1154394286
Name:KELTER, RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:KELTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 STONY HILL DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1176
Mailing Address - Country:US
Mailing Address - Phone:732-580-9248
Mailing Address - Fax:732-536-0248
Practice Address - Street 1:15 STONY HILL DR
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1176
Practice Address - Country:US
Practice Address - Phone:732-580-9248
Practice Address - Fax:732-536-0248
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA035497207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31D0114041OtherCLIA
NJ0674206Medicaid
NJKE445284Medicare ID - Type Unspecified