Provider Demographics
NPI:1316933914
Name:KELLER, DAVID JAY (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAY
Last Name:KELLER
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 1:3 ALBERT CREE DR
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4601
Mailing Address - Country:US
Mailing Address - Phone:802-775-2937
Mailing Address - Fax:802-773-0934
Practice Address - Street 1:44 BIRCH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2752
Practice Address - Country:US
Practice Address - Phone:603-421-9130
Practice Address - Fax:603-421-2451
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420005877174400000X
NHLT-2804207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT329603OtherCIGNA
VT0004705Medicaid
VT00004705OtherBCBS OF VT
NH30208575Medicaid
VT4971OtherCAPITAL DIST PHY HEALTH P
VT18145OtherMOHAWK VALLEY PHYSICIAN
VTD78572Medicare UPIN
VT0004705Medicaid
VT4971OtherCAPITAL DIST PHY HEALTH P