Provider Demographics
NPI:1528064094
Name:KELLER, LARRY (DO)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:KELLER
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Gender:M
Credentials:DO
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Mailing Address - Street 1:1235 OLD YORK RD
Mailing Address - Street 2:STE 210
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3841
Mailing Address - Country:US
Mailing Address - Phone:215-884-0959
Mailing Address - Fax:215-884-9533
Practice Address - Street 1:1811 BETHLEHEM PIKE
Practice Address - Street 2:A-108
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1111
Practice Address - Country:US
Practice Address - Phone:215-884-0959
Practice Address - Fax:215-884-9533
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2021-07-12
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Provider Licenses
StateLicense IDTaxonomies
PAOS007193L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA756230Medicare PIN