Provider Demographics
NPI:1427120583
Name:KEELEY, BRIAN CHARLES (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:CHARLES
Last Name:KEELEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CAVALIER DRIVE
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002
Mailing Address - Country:US
Mailing Address - Phone:215-646-0969
Mailing Address - Fax:215-643-8363
Practice Address - Street 1:10 CAVALIER DRIVE
Practice Address - Street 2:AMBLER FAMILY PRACTICE
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002
Practice Address - Country:US
Practice Address - Phone:215-646-0969
Practice Address - Fax:215-643-8363
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05008541L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01614264Medicaid
PA01614264Medicaid
G30469Medicare UPIN