Provider Demographics
NPI:1154406932
Name:KELLER, MAUREEN (DO)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 ROUTE 130 SOUTH
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-0765
Mailing Address - Country:US
Mailing Address - Phone:856-764-4115
Mailing Address - Fax:856-764-4116
Practice Address - Street 1:2906 ROUTE 130 SOUTH
Practice Address - Street 2:SUITE 201
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-0765
Practice Address - Country:US
Practice Address - Phone:856-764-4115
Practice Address - Fax:856-764-4116
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07370900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ063206Medicare ID - Type Unspecified
NJH71485Medicare UPIN