Provider Demographics
NPI:1538211941
Name:CARAMELLI, KEITH (MD PHSYCHIATRIST)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:CARAMELLI
Suffix:
Gender:M
Credentials:MD PHSYCHIATRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 W STASSNEY LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-2947
Mailing Address - Country:US
Mailing Address - Phone:512-440-4800
Mailing Address - Fax:512-440-4835
Practice Address - Street 1:3101 S AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7541
Practice Address - Country:US
Practice Address - Phone:512-440-4800
Practice Address - Fax:512-440-4835
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ15962084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX849176OtherBCBS
TX139085815Medicaid