Provider Demographics
NPI:1962400994
Name:KELLER, TERESA H (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:H
Last Name:KELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 S DUPONT HWY
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1027
Mailing Address - Country:US
Mailing Address - Phone:302-422-2022
Mailing Address - Fax:302-422-5366
Practice Address - Street 1:16 S DUPONT HWY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1027
Practice Address - Country:US
Practice Address - Phone:302-422-2022
Practice Address - Fax:302-422-5366
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2013-10-14
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
DEC1-00024162080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000092301Medicaid
DE00069813000OtherAMERIHEALTH
DED01017Medicare UPIN